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1. THE GLOBAL MARKET OF SMALL BUSINESSES BY E-COMMERCE PLATFORMS

Author

Domenico CONSOLI

Subjects
Small Business, e-commerce, ICT, social media, web 2.0, global market., Social sciences (General), H1-99
Abstract

Nowadays we live in a global market era. For small businesses (SBs), that do not have financial and human resources, to sell in a big market by an e-commerce platform can be a competitive strategy. The electronic platform can reinforce the weaknesses of an absence of a commercial network to interact with end customers, especially if they live in another country. The platform allows small businesses to operate on the long tail. In fact they can sell also few specific products /services to a large number of people in a global context. Obviously, in economic terms, Small Businesses cannot compete with the big ones that can have most advanced technology and software for information processing. However, for SBs the reduced availability of resources is not an impediment to sell in a global market. Owners of SBs can directley spend and devote part of their free time to support the online sale. Being lean and flexible enterprises they can execute more quickly orders, collected by the website, and therefore the distribution process is more fast. In the paper we describe a research on e-commerce in a small companies sample and in particular an analisys of websites and interviews, in dept, to entrepreneurs.

Published
2016

2. 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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3. The Integration of Interactive and Collaborative Tools 2.0 in Websites of Micro and Small Enterprises

Author

Domenico Consoli

Subjects
web 2.0, enterprise 2.0, web-oriented technology, micro and small enterprises, innovative technologies, Psychology, BF1-990, Economics as a science, HB71-74
Abstract

Nowadays also micro and small companies use interactive web sites that integrate some tools 2.0 (chat, blogs, forums, ...) and links to social networks, such as Facebook and Twitter, to interface with the external environment. By these new tools companies can interacts with all stakeholders of the supply chain and in particular with customers to improve their products/services. In this way between customers and company a bidirectional channel is established and a process of co-creation and co-production of products/services is stimulated. Small enterprises should take advantage using these technological channels to increase the competitiveness. In this paper we analyse the state of the art about the use of interactive and collaborative tools in websites of micro and small companies that have introduced some experimentations in this direction. The analysis is oriented to understand if entrepreneurs or managers think that these new digital channels are important in reaching business goals.

Published
2015

4. 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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5. A Conceptual Model to Implement an Interactive and Collaborative Enterprise 2.0

Author

Domenico CONSOLI

Subjects
Web 2.0, Enterprise 2.0, Implementation Procedure, Platform 2.0, Performance, Computer engineering. Computer hardware, TK7885-7895, Bibliography. Library science. Information resources
Abstract

To implement an interactive and collaborative Enterprise 2.0 it is important to have, inside the company, organizational and technological preconditions. In this model of advanced enterprise, internal workers must collaborate among themselves to communicate with all external subjects of the supply chain for achieving business goals. The implementation process is a critical and complex procedure that requires a strategic plan in the introduction and adoption of the innovation. In this paper the single actions to follow, for the implementation of the new model of business, with all determinant factors and variables, are described.

Published
2013
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6. A Collaborative Platform to Support the Enterprise 2.0 in Active Interactions with Customers

Author

Domenico CONSOLI

Subjects
Web 2.0, Enterprise 2.0, Collaborative Tools, Opinion Mining, SOA, Legacy Systems, Computer engineering. Computer hardware, TK7885-7895, Bibliography. Library science. Information resources
Abstract

In recent years a new model of Enterprise 2.0, which interacts actively with customers using web 2.0 tools (chat, forum, blog, wiki), is developing. The enterprises, listening opinions and suggestions of customers, can improve the product/service. For a company, customer's opinions are very important both for the improvement of products and also for the reinforcement of the customer loyalty. The customer will be motivated to be loyal if the enterprise shows a strong attention to his/her needs. This paper presents a model of a collaborative and interactive platform that supports the Enterprise 2.0 in the management of communications and relationships with all stakeholder of the supply chain and in particular with customers. A good e-reputation of the company improves business performances.

Published
2012

7. A Layered Software Architecture for the Management of a Manufacturing Company

Author

Domenico CONSOLI

Subjects
ICT, Service Oriented Architecture, Web Services, Computer-Integrated Factory, Application Software, Computer engineering. Computer hardware, TK7885-7895, Bibliography. Library science. Information resources
Abstract

In this paper we describe a layered software architecture in the management of a manufactur-ing company that intensively uses computer technology. Application tools, new and legacy, after the updating, operate in a context of an open web oriented architecture. The software architecture enables the integration and interoperability among all tools that support business processes. Manufacturing Executive System and Text Mining tools are excellent interfaces, the former both for internal production and management processes and the latter for external processes coming from the market. In this way, it is possible to implement, a computer integrated factory, flexible and agile, that immediately responds to customer requirements.

Published
2011

11. The SITS Open Study

Author

Niaz Ahmed, Kennedy R. Lees, Rudiger von Kummer, Staffan Holmin, Irene Escudero-Martinez, Matteo Bottai, Olav Jansen, Nils Wahlgren, Alessandro De Vito, Domenico Consoli, Stefan Müller-Hülsbeck, Satu Mustanoja, Jan-Erik Karlsson, Alexander Rentzos, Tiago Moreira, Yakup Krespi, Sven Poli, Salvatore Mangiafico, Elke Grewski, Ana Paiva Nunes, Isabel Fragata, Lars Krause, Geert Vanhooren, Arnstein Tveiten, Christian Weimar, Gabor Petzold, Sönke Langner, Rafael L Vasconcelos e Castro de Freitas, M. Aguilar, Lucio Castellan, Jayan Chembala, Albrecht Günther, and Bo Danielsson

Subjects
Male, medicine.medical_specialty, Computed Tomography Angiography, medicine.medical_treatment, Brain Ischemia, ischemic stroke, medicine, Cluster Analysis, Humans, Prospective Studies, Stroke, propensity score, Ischemic Stroke, Thrombectomy, Aged, Randomized Controlled Trials as Topic, Advanced and Specialized Nursing, business.industry, Endovascular Procedures, Large artery occlusion, Stent, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Surgery, Clinical Practice, Open study, Treatment Outcome, thrombectomy, Ischemic stroke, Propensity score matching, stent, Female, Stents, Neurology (clinical), Open label, Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, business, Follow-Up Studies
Abstract

Background and Purpose: We designed SITS (Safe Implementation of Treatment in Stroke) Open to determine benefit and safety of thrombectomy in clinical practice for large artery occlusion stroke, using selected stent retrievers plus standard care versus standard care alone. Methods: SITS Open was a prospective, open, blinded evaluation, international, multicenter, controlled, nonrandomized registry study. Centers lacking access to thrombectomy contributed controls. Primary end point was categorical shift in modified Rankin Scale score at 3 months in the per protocol (PP) population. Principal secondary outcomes were symptomatic intracranial hemorrhage, functional independency (modified Rankin Scale score 0–2) and death at 3 months. Patients independently evaluated by video-recorded modified Rankin Scale interviews blinded to treatment or center identity by central core laboratory were regarded as PP population. Propensity score matching with covariate adjusted analysis was performed. Results: During 2014 to 2017, 293 patients (257 thrombectomy, 36 control) from 26 centers in 10 countries fulfilled intention-to-treat and 200 (170 thrombectomy, 30 control) PP criteria; enrollment of controls was limited by rapid uptake of thrombectomy. In PP analysis, median age was 71 versus 71 years, and baseline National Institutes of Health Stroke Scale 17 versus 17 in the thrombectomy and control arms, respectively. The propensity score matching analysis for PP showed a significant shift for modified Rankin Scale at 3 months favoring the thrombectomy group (odds ratio, 3.8 [95% CI, 1.61–8.95]; P =0.002). Regarding safety, there were 4 cases of symptomatic intracranial hemorrhage in the thrombectomy group (2.4%) and none in the control group. Conclusions: In clinical practice, thrombectomy for patients with large artery occlusion stroke is superior to standard of care in our study. Registration: URL: https://www.clinicaltrials.gov . Unique Identifier: NCT02326428.

Published
2021
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12. Prevalence of Atrial Fibrillation Subtypes in Italy and Projections to 2060 for Italy and Europe

Author

Augusto Zaninelli, Marzia Baldereschi, Maria Grazia DʼAlfonso, Giovanni Pracucci, Alessandro Cattarinussi, Benedetta Piccardi, Leonardo Bellino, Bianca Maria Polizzi, Fabio Mori, Chiara Gradia, Domenico Consoli, Domenico Inzitari, Antonio Di Carlo, and Bruno Sgherzi

Subjects
Male, medicine.medical_specialty, Population, 030204 cardiovascular system & hematology, Risk Assessment, Older population, Electrocardiography, 03 medical and health sciences, Age Distribution, 0302 clinical medicine, Atrial Fibrillation, Epidemiology, Prevalence, medicine, Humans, Mass Screening, media_common.cataloged_instance, 030212 general & internal medicine, Sex Distribution, European union, education, Stroke, Opportunistic screening, Aged, media_common, Aged, 80 and over, education.field_of_study, business.industry, Atrial fibrillation, medicine.disease, Confidence interval, Europe, Cross-Sectional Studies, Italy, Female, Geriatrics and Gerontology, business, Demography
Abstract

BACKGROUND/OBJECTIVES Atrial fibrillation (AF) subtypes may carry different cardiovascular risk profiles, but information on their frequency from population-based studies is lacking. We estimated prevalence of AF subtypes in a representative sample of the Italian older population, projecting figures for Italy and the European Union. DESIGN Cross-sectional study. SETTING Three primary care practices in northern, central, and southern Italy. PARTICIPANTS All individuals aged 65 years or older, for a total sample of 6,016 subjects. Excluding 235 noneligible, participation was 78.3%, which left 4,528 participants. MEASUREMENTS A double systematic and opportunistic screening procedure identified possible AF cases, followed by clinical and electrocardiogram confirmation. Patients were categorized with paroxysmal, persistent, or permanent AF. Prevalence was calculated by sex and 5-year age groups. Prevalence figures were applied to population projections for all 28 European Union states to estimate AF subtypes expected in future decades. RESULTS In the 4,528 participants (mean age = 74.5 ± 6.8 years; 47.2% men), 331 AF cases were identified: 140 (42.3%) paroxysmal, 77 (23.3%) persistent, and 114 (34.4%) permanent. Prevalence was 3.1% (95% confidence interval (CI) = 2.6%-3.6%) for paroxysmal, 1.7% (95% CI = 1.4%-2.1%) for persistent, and 2.5% (95% CI = 2.1%-3.0%) for permanent AF. Italian older persons having AF in 2016 were estimated at approximately 449,000 for paroxysmal, approximately 240,000 for persistent, and approximately 391,000 for permanent AF, projected to increase in 2060 to approximately 785,000, approximately 358,000, and approximately 748,000, respectively. European Union older persons having AF in 2016 were estimated at approximately 3,185,000 for paroxysmal, approximately 1,722,000 for persistent, and approximately 2,710,000 for permanent AF, projected to increase in 2060 to approximately 5,989,000, approximately 2,833,000, and approximately 5,579,000, respectively. CONCLUSION We provided first projections of AF subtypes for Italy and Europe. The worse cardiovascular risk profile of persistent and permanent forms indicates an increased burden in future decades.

Published
2020
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13. Clinical RoPE (cRoPE) score predicts patent foramen ovale detection among stroke patients: a multicenter observational study

Author

Paolo Eusebi, Franco Galati, Antonio Vecchio, Chiara Padiglioni, Domenico Consoli, Stefano Ricci, Anna Mengoni, Silvia Cenciarelli, David Giannandrea, and Michele Romoli

Subjects
TOAST Classification, medicine.medical_specialty, business.industry, Dermatology, General Medicine, medicine.disease, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Paradoxical embolism, Internal medicine, Cohort, Attributable risk, medicine, Cardiology, Patent foramen ovale, 030212 general & internal medicine, Neurology (clinical), Prospective cohort study, business, Stroke, 030217 neurology & neurosurgery, Neuroradiology
Abstract

The role of patent foramen ovale (PFO) in cryptogenic stroke (CS) is debated. Tools to predict PFO occurrence and attributable fraction are needed to guide cost-effective diagnostics and treatment. Risk of Paradoxical Embolism (RoPE) score relies on neuroimaging findings, which might be inconclusive in up to 30% of cases. We developed a clinical-based easy tool to predict the presence and attributable fraction of PFO in CS patients, without using neuroimaging. The clinical RoPE (cRoPE) score, ranging 1–10, was elaborated through Delphi method from the original RoPE score, replacing cortical infarction with the Oxfordshire Community Stroke Project (OCSP) classification (lacunar stroke = 0 points, other subtypes = 1 point). Then, from the SISIFO (Studio Italiano di prevalenza nello Stroke Ischemico di pervieta del Forame Ovale, or Prevalence of Patent Foramen Ovale in Ischemic Stroke in Italy) study, a multicenter, prospective study on consecutive acute ischemic stroke patients (n = 1130) classified by Trial of Org 10172 in Acute Stroke Treatment (TOAST) and OCSP criteria and undergoing PFO testing, we selected the VV-CDC cohort (Vibo Valentia, Citta di Castello, n = 323) to test the accuracy of cRoPE in predicting PFO detection. We compared cRoPE with RoPE to verify cRoPE reliability. Finally, we tested, through ROC analysis, the performance of cRoPE depending on TOAST classification. Overall, PFO was detected in 21% in VV-CDC and in 23.4% in remaining SISIFO cohort (n = 807). cRoPEAUC and RoPEAUC were similar in VV-CDC. cRoPE performance was comparable with RoPE among CS (cRoPEAUC 0.76, 95%CI 0.67–0.85, RoPEAUC 0.75, 95%CI 0.66–0.84). Moving to the remaining SISIFO cohort, cRoPE confirmed satisfactory accuracy in predicting PFO detection in CS patients (cRoPEAUC 0.71, 95%CI 0.66–0.78, p = 0.032). Conclusions: cRoPE might help in stratification of patients with CS, allowing accurate esteem of the likelihood of PFO to be found, especially in cases when neuroimaging is inconclusive.

Published
2020
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14. Bridging versus Direct Mechanical Thrombectomy in Acute Ischemic Stroke: A Subgroup Pooled Meta-Analysis for Time of Intervention, Eligibility, and Study Design

Author

Domenico Consoli, Michele Romoli, Simone Vidale, and Elio Agostoni

Subjects
Male, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Clinical Decision-Making, Eligibility Determination, Subgroup analysis, 030204 cardiovascular system & hematology, Risk Assessment, Brain Ischemia, Time-to-Treatment, law.invention, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Randomized controlled trial, Risk Factors, Modified Rankin Scale, law, Internal medicine, medicine, Clinical endpoint, Humans, Thrombolytic Therapy, Prospective cohort study, Aged, Thrombectomy, Aged, 80 and over, business.industry, Endovascular Procedures, Recovery of Function, Thrombolysis, Middle Aged, Stroke, Treatment Outcome, Neurology, Research Design, Meta-analysis, Number needed to treat, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Background and Aim: The risk/benefit profile of intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) in acute ischemic stroke is still unclear. We provide a systematic review and meta-analysis including studies comparing direct EVT (dEVT) vs. bridging treatment (IVT + EVT), defining the impact of treatment timing and eligibility to IVT on functional status and mortality. Methods: Protocol was registered with PROSPERO (CRD42019135915) and followed PRISMA guidelines. PubMed, EMBASE, and Cochrane Central were searched for randomized controlled trials (RCTs), retrospective, and prospective studies comparing IVT + EVT vs. dEVT in adults (≥18) with acute ischemic stroke. Primary endpoint was functional independence at 90 days (modified Rankin Scale 2a), (ii) mortality, and (iii) symptomatic intracranial hemorrhage (sICH). Subgroup analysis was performed according to study type, eligibility to IVT, and onset-to-groin timing (OGT), stratifying studies for similar OGT. ORs for endpoints were pooled with meta-analysis and compared between reperfusion strategies. Results: Overall, 35 studies were included (n = 9,117). No significant differences emerged comparing patients undergoing dEVT and bridging treatment for gender, hypertension, diabetes, National Institute of Health Stroke Scale score at admission. Regarding primary endpoint, IVT + EVT was superior to dEVT (OR 1.44, 95% CI 1.22–1.69, p < 0.001, pheterogeneityConclusions: Compared to dEVT, IVT + EVT associates with better functional outcome and lower mortality. Post hoc data from RCTs point to substantial equivalence of reperfusion strategies. Therefore, an adequately powered RCTs comparing dEVT versus IVT + EVT are warranted.

Published
2020
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15. 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. Influence of atrial fibrillation subtypes on anticoagulant therapy in a high-risk older population: the FAI project

Author

Antonio, Di Carlo, Fabio, Mori, Domenico, Consoli, Leonardo, Bellino, Augusto, Zaninelli, Marzia, Baldereschi, Maria Grazia, D'Alfonso, Chiara, Gradia, Alessandro, Cattarinussi, Bruno, Sgherzi, Giovanni, Pracucci, Benedetta, Piccardi, Bianca Maria, Polizzi, and Domenico, Inzitari

Subjects
Aged, 80 and over, Male, Stroke, Cross-Sectional Studies, Risk Factors, Atrial Fibrillation, Administration, Oral, Anticoagulants, Humans, Female, Aged, Factor Xa Inhibitors
Abstract

Benefits of oral anticoagulants (OAC) in atrial fibrillation (AF) patients with moderate-to-high risk of stroke are independent of AF pattern. We evaluated whether AF clinical subtype influenced OAC use in a representative sample of the Italian older population.A cross-sectional examination of all subjects aged 65 + years from three general practices in northern, central, and southern Italy started in 2016. A double-screening procedure was followed by clinical and ECG confirmation. Patients were categorized as having paroxysmal, persistent, or permanent AF. OAC use was evaluated in confirmed AF patients.The sample included 6016 subjects. Excluding 235 non-eligible, participation was 78.3%, which left 4528 participants (mean age 74.5 ± 6.8 years, 47.2% men). Overall, 319 AF cases were identified: 43.0% had paroxysmal, 21.3% persistent, and 35.7% permanent AF. Frequency of OAC therapy was 91.2% in permanent, 85.3% in persistent, and only 43.0% in paroxysmal AF (P 0.001). In multivariate analysis, controlled for baseline variables and risk scales, persistent and permanent AF were associated with a significant increase in the likelihood of receiving OAC compared with paroxysmal AF (P 0.001). This was confirmed for permanent AF also in multivariate analyses considering separately vitamin K antagonists or direct-acting oral anticoagulants (OR, 4.37, 95% CI, 2.43-7.85; and 1.92, 95% CI, 1.07-3.42, respectively) and for persistent AF and direct-acting oral anticoagulants (OR, 4.33, 95% CI, 2.30-8.15).In a population-based survey, AF pattern was an independent predictor of OAC treatment. Paroxysmal AF is still perceived as carrying a lower risk of vascular events.

Published
2021

18. 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
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19. Hypertension, seizures, and epilepsy: a review on pathophysiology and management

Author

Chiara Sueri, Alberto Primavera, Giovambattista De Sarro, Vincenzo Belcastro, Angelo Labate, Salvatore M Cavalli, Fabrizio A. de Falco, Vittoria Cianci, Giancarlo Di Gennaro, Umberto Aguglia, Sara Gasparini, Roberto Michelucci, Ettore Beghi, Emilio Russo, Michele Ascoli, Antonio Gambardella, Pasquale Palumbo, Ferdinando Sartucci, Amedeo Bianchi, Gian Luigi Gigli, Alfonso Iudice, Paolo Benna, Flavio Villani, Roberto Cantello, Edoardo Ferlazzo, Domenico Consoli, Maurizio Paciaroni, and Pasquale Striano

Subjects
Pediatrics, medicine.medical_specialty, Neurology, Dermatology, Disease, Epileptogenesis, 03 medical and health sciences, Epilepsy, 0302 clinical medicine, Seizures, Hypertension, Posterior reversible encephalopathy syndrome, Stroke, 2708, Neurology (clinical), Psychiatry and Mental Health, medicine, Humans, 030212 general & internal medicine, business.industry, Symptomatic seizures, General Medicine, medicine.disease, Psychiatry and Mental health, Blood pressure, Cerebral Small Vessel Diseases, business, 030217 neurology & neurosurgery
Abstract

Background: Epilepsy and hypertension are common chronic conditions, both showing high prevalence in older age groups. This review outlines current experimental and clinical evidence on both direct and indirect role of hypertension in epileptogenesis and discusses the principles of drug treatment in patients with hypertension and epilepsy. Methods: We selected English-written articles on epilepsy, hypertension, stroke, and cerebrovascular disease until December, 2018. Results: Renin-angiotensin system might play a central role in the direct interaction between hypertension and epilepsy, but other mechanisms may be contemplated. Large-artery stroke, small vessel disease and posterior reversible leukoencephalopathy syndrome are hypertension-related brain lesions able to determine epilepsy by indirect mechanisms. The role of hypertension as an independent risk factor for post-stroke epilepsy has not been demonstrated. The role of hypertension-related small vessel disease in adult-onset epilepsy has been demonstrated. Posterior reversible encephalopathy syndrome is an acute condition, often caused by a hypertensive crisis, associated with the occurrence of acute symptomatic seizures. Chronic antiepileptic treatment should consider the risk of drug-drug interactions with antihypertensives. Conclusions: Current evidence from preclinical and clinical studies supports the vision that hypertension may be a cause of seizures and epilepsy through direct or indirect mechanisms. In both post-stroke epilepsy and small vessel disease-associated epilepsy, chronic antiepileptic treatment is recommended. In posterior reversible encephalopathy syndrome blood pressure must be rapidly lowered and prompt antiepileptic treatment should be initiated.

Published
2019
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20. Head Injuries

Author

Marina Diomedi, Domenico Consoli, Corrado Iaccarino, Pierpaolo Lunardi, Federica Novegno, and Leandro Provinciali

Published
2021

21. The PRIAMO study: age- and sex-related relationship between prodromal constipation and disease phenotype in early Parkinson’s disease

Author

L Grasso, Silvia Ramat, Simone Gallerini, Paolo Barone, G. Di Brigida, D. Fogli, Tommaso Scaravilli, M. Braga, Alessandra Nicoletti, M. Romeno, Paolo Martinelli, G. Gurgone, Cesare Colosimo, E. Pilleri, V. Sorbello, S. Amidei, F. Pennisi, Francesco Iemolo, Giorgio Trianni, Vincenzo Toni, E. Milan, Raffaele Palladino, D. Benincasa, Giovanni Pezzoli, M. G. Randisi, Alfredo Petrone, Arianna Guidubaldi, R. Alfano, Tania P. Avarello, A. Scaglioni, Anna Rita Bentivoglio, C. Modica, L. Ferigo, M. Manfredi, Domenico Consoli, Giuseppe Meco, Giampiero Volpe, S. Griffini, Francesca Morgante, R. Scala, G. Nordera, Angelo Antonini, G. Floris, Roberto Erro, R. Muoio, Salvatore Zappulla, Luigi Bartolomei, Edo Bottacchi, Antonio Pisani, V. Petretta, Giovanni Fabbrini, G. Ciacci, L. Maiello, G. Ceravolo, M. Di Giovanni, V. Nastasi, Rocco Quatrale, D. Tiple, Marcello Deriu, S. Lanfranchi, Marianna Capecci, Alberto Albanese, T. Cuomo, Francesco E. Pontieri, Vincenzo Moschella, G. Sciortino, F. A. De Falco, S. Biguzzi, Leonardo Lopiano, Marina Picillo, C. Alesi, D. De Gaspari, Michele Abrignani, Gabriella Santangelo, Fabrizio Stocchi, R. Luciano, M. Baratti, R. M. Giglia, Cesa Scaglione, B. Troianiello, Giovanni Abbruzzese, M. Mucchiut, F. Pepe, S. Zanini, L. Capus, N. Caravona, Giovanni Cossu, V. Agnetti, G. Albani, L. Kiferle, E. Giaccaglini, Roberto Marconi, M. Iellamo, R. Marano, D. Medici, Monica Ulivelli, G. A. Cocco, M. Perini, P. Del Dotto, Rosa M. Gaglio, Rodolfo Savica, C. Logi, G. Ciccarelli, P. Massimo, M. Pesare, Antonino Cannas, Roberto Ceravolo, P. Simone, Letterio Morgante, P. Soliveri, S. Meoni, Picillo, M., Palladino, R., Erro, R., Alfano, R., Colosimo, C., Marconi, R., Antonini, A., Barone, P., Morgante, L., Benincasa, D., Quatrale, R., Biguzzi, S., Braga, M., Ceravolo, G., Capecci, M., Meco, G., Caravona, N., Scala, R., De Falco, F. A., Pezzoli, G., De Gaspari, D., Bottacchi, E., Di Giovanni, M., Cannas, A., Floris, G., Gallerini, S., Grasso, L., Gaglio, R. M., Gurgone, G., Volpe, G., Zappulla, S., Ceravolo, R., Kiferle, L., Ramat, S., Meoni, S., Pisani, A., Moschella, V., Morgante, F., Savica, R., Pepe, F., Ciccarelli, G., Petretta, V., Giglia, R. M., Randisi, M. G., Iemolo, F., Avarello, T. P., Romeno, M., Santangelo, G., Stocchi, F., Sciortino, G., Sorbello, V., Nicoletti, A., Tiple, D., Fabbrini, G., Bentivoglio, A., Pontieri, F. E., Guidubaldi, A., Muoio, R., Toni, V., Del Dotto, P., Logi, C., Ciacci, G., Ulivelli, M., Perini, M., Lanfranchi, S., Griffini, S., Troianiello, B., Baratti, M., Amidei, S., Consoli, D., Iellamo, M., Cuomo, T., Scaglioni, A., Medici, D., Manfredi, M., Abbruzzese, G., Di Brigida, G., Cocco, G. A., Agnetti, V., Cossu, G., Deriu, M., Abrignani, M., Modica, C., Albani, G., Milan, E., Martinelli, P., Scaglione, C., Mucchiut, M., Zanini, S., Pennisi, F., Soliveri, P., Albanese, A., Massimo, P., Bartolomei, L., Capus, L., Ferigo, L., Marano, R., Nastasi, V., Luciano, R., Maiello, L., Simone, P., Fogli, D., Lopiano, L., Pesare, M., Nordera, G., Pilleri, E., Scaravilli, T., Giaccaglini, E., Alesi, C., Petrone, A., and Trianni, G.

Subjects
Male, Neurology, Parkinson's disease, Constipation, Heterogeneity, Parkinson, Phenotype, Prodromal, Sex, PROGRESSION, Disease, 0302 clinical medicine, Apathy, Neuroradiology, Original Communication, Cognition, Parkinson Disease, 030211 gastroenterology & hepatology, Female, medicine.symptom, NONMOTOR SYMPTOMS, Life Sciences & Biomedicine, PRIAMO study group, Human, medicine.medical_specialty, Clinical Neurology, Prodromal Symptoms, Prodromal Symptom, 03 medical and health sciences, Internal medicine, medicine, Humans, Clinical phenotype, Aged, Science & Technology, Neurology & Neurosurgery, business.industry, 1103 Clinical Sciences, Biomarker, medicine.disease, DYSFUNCTION, Biomarkers, Neurology (clinical), Neurosciences & Neurology, business, 1109 Neurosciences, 030217 neurology & neurosurgery
Abstract

Objectives To explore the impact of sex and age on relationship between prodromal constipation and disease phenotype in Parkinson’s disease at early stages. Methods A total of 385 Parkinson’s disease patients from the PRIAMO study were classified according to the presence of prodromal constipation and followed for 24 months. Multivariable mixed-effect models were applied. All analyses were performed separately for sex (64.1% men) and median age (different by sex: 67 years-old in men and 68 years-old in women). Results As for sex, prodromal constipation was associated with greater odds of attention/memory complaints and apathy symptoms in women only. As for age, prodromal constipation was associated with lower cognitive and higher apathy scores in older patients only. Conclusions Prodromal constipation anticipates lower cognitive performances and more severe apathy since the earliest stages in women and older patients. Sex- and age-related heterogeneity of prodromal markers of Parkinson’s disease may impact disease phenotype.

Published
2021

22. Delirium/Acute Confusional State

Author

Maurizio Melis, Fabio Minicucci, Enrico Mossello, Domenico Consoli, Roberto Sterzi, Fabrizio A. de Falco, and Maria Vittoria Calloni

Subjects
medicine.medical_specialty, Disturbance (geology), business.industry, media_common.quotation_subject, Cognition, behavioral disciplines and activities, nervous system diseases, Physical medicine and rehabilitation, mental disorders, medicine, Delirium, Transient (oscillation), Consciousness, medicine.symptom, business, media_common
Abstract

Delirium is classically defined as an acute, transient, global, organic disturbance of cognitive functions that leads to loss of attention and fluctuating impairment of consciousness.

Published
2020
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23. Clinical RoPE (cRoPE) score predicts patent foramen ovale detection among stroke patients: a multicenter observational study

Author

David, Giannandrea, Chiara, Padiglioni, Paolo, Eusebi, Anna, Mengoni, Michele, Romoli, Franco, Galati, Antonio, Vecchio, Silvia, Cenciarelli, Stefano, Ricci, and Domenico, Consoli

Subjects
Stroke, Italy, Risk Factors, Foramen Ovale, Patent, Humans, Reproducibility of Results, Prospective Studies, Brain Ischemia, Embolism, Paradoxical
Abstract

The role of patent foramen ovale (PFO) in cryptogenic stroke (CS) is debated. Tools to predict PFO occurrence and attributable fraction are needed to guide cost-effective diagnostics and treatment. Risk of Paradoxical Embolism (RoPE) score relies on neuroimaging findings, which might be inconclusive in up to 30% of cases.We developed a clinical-based easy tool to predict the presence and attributable fraction of PFO in CS patients, without using neuroimaging. The clinical RoPE (cRoPE) score, ranging 1-10, was elaborated through Delphi method from the original RoPE score, replacing cortical infarction with the Oxfordshire Community Stroke Project (OCSP) classification (lacunar stroke = 0 points, other subtypes = 1 point). Then, from the SISIFO (Studio Italiano di prevalenza nello Stroke Ischemico di pervietà del Forame Ovale, or Prevalence of Patent Foramen Ovale in Ischemic Stroke in Italy) study, a multicenter, prospective study on consecutive acute ischemic stroke patients (n = 1130) classified by Trial of Org 10172 in Acute Stroke Treatment (TOAST) and OCSP criteria and undergoing PFO testing, we selected the VV-CDC cohort (Vibo Valentia, Città di Castello, n = 323) to test the accuracy of cRoPE in predicting PFO detection. We compared cRoPE with RoPE to verify cRoPE reliability. Finally, we tested, through ROC analysis, the performance of cRoPE depending on TOAST classification.Overall, PFO was detected in 21% in VV-CDC and in 23.4% in remaining SISIFO cohort (n = 807). cRoPEConclusions: cRoPE might help in stratification of patients with CS, allowing accurate esteem of the likelihood of PFO to be found, especially in cases when neuroimaging is inconclusive.

Published
2020

24. Small vessel disease and biomarkers of endothelial dysfunction after ischaemic stroke

Author

Francesco Arba, Giovanni Orlandi, Benedetta Piccardi, Anna Maria Gori, Francesca Massaro, Rosanna Abbate, Mascia Nesi, Alessio Giannini, Giorgio Bono, Vanessa Palumbo, Paolo Bovi, Danilo Toni, Silvia Biagini, Rossana Tassi, Enrico Fainardi, Maria Sessa, Patrizia Nencini, Giovanni Pracucci, Betti Giusti, Francesco Perini, Domenico Consoli, Domenico Inzitari, and Antonia Nucera

Subjects
Pathology, medicine.medical_specialty, acute stroke, endothelial dysfunction, intercellular adhesion molecule, Small vessel disease, vascular cell adhesion molecule, vascular endothelial growth factor, Disease, 030204 cardiovascular system & hematology, Pathogenesis, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Original Research Articles, Ischaemic stroke, medicine, Endothelial dysfunction, Acute stroke, business.industry, Small vessel disease, endothelial dysfunction, intercellular adhesion molecule, vascular cell adhesion molecule, vascular endothelial growth factor, acute stroke, Intercellular adhesion molecule, medicine.disease, Vascular endothelial growth factor, chemistry, Neurology (clinical), Small vessel, Cardiology and Cardiovascular Medicine, business, 030217 neurology & neurosurgery
Abstract

Introduction Although pathogenesis of small vessel disease is poorly understood, increasing evidence suggests that endothelial dysfunction may have a relevant role in development and progression of small vessel disease. In this cross-sectional study, we investigated the associations between imaging signs of small vessel disease and blood biomarkers of endothelial dysfunction at two different time points in a population of ischaemic stroke patients. Patients and methods In stroke patients treated with intravenous thrombolysis, we analysed blood levels of von Willebrand factor, intercellular adhesion molecule-1, vascular cell adhesion molecule-1 and vascular endothelial growth factor. Three reviewers independently assessed small vessel disease features using computed tomography. At baseline and 90 days after the index stroke, we tested the associations between single and combined small vessel disease features and levels of blood biomarkers using linear regression analysis adjusting for age, sex, hypertension, diabetes, smoke. Results A total of 263 patients were available for the analysis. Mean age (±SD) was 69 (±13) years, 154 (59%) patients were male. We did not find any relation between small vessel disease and endothelial dysfunction at baseline. At 90 days, leukoaraiosis was independently associated with intercellular adhesion molecule-1 (β = 0.21; p = 0.016) and vascular cell adhesion molecule-1 (β = 0.22; p = 0.009), and lacunes were associated with vascular endothelial growth factor levels (β = 0.21; p = 0.009) whereas global small vessel disease burden was associated with vascular endothelial growth factor (β = 0.26; p = 0.006). Discussion Leukoaraiosis and lacunes were associated with endothelial dysfunction, which could play a key role in pathogenesis of small vessel disease. Conclusions Small vessel disease features and total burden were associated with endothelial dysfunction 90 days after the stroke, whereas there was no relation during the acute phase. Our results suggest that endothelial dysfunction, particularly vascular endothelial growth factor, is involved in pathological process of small vessel disease.

Published
2018
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25. Genomic analysis identify a new EIF2B3 gene variant detected in an uncertain case of CADASIL disease

Author

Luigi Citrigno, Domenico Consoli, Rosalucia Mazzei, Nelide Romeo, Pierluigi Lanza, Flavia Propato, Annamaria Cerantonio, Selene De Benedittis, Olivier Gallo, Maria Muglia, Angelo Bagalà, Antonio Cerasa, Gemma Di Palma, Patrizia Spadafora, Antonio Qualtieri, and Francesca Cavalcanti

Subjects
Genetics, Neurology, medicine, Genetic variants, Neurology (clinical), Disease, Biology, CADASIL, medicine.disease
Published
2021
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26. Decision Algorithms for Emergency Neurology

Author

Giuseppe Micieli, Anna Cavallini, Stefano Ricci, Domenico Consoli, Jonathan A. Edlow, Giuseppe Micieli, Anna Cavallini, Stefano Ricci, Domenico Consoli, and Jonathan A. Edlow

Subjects
Nervous system--Diseases--Diagnosis, Neurological emergencies
Abstract

This book adopts a novel approach: procedures: instead of discussing the diagnostic categories of neurological syndromes, it focuses on the symptoms of common neurological presentations (especially in the emergency room or on the ward), and the diagnostic hypotheses that can be validated or rejected case by case as a result. Each chapter covers one of the main symptoms of emergencies in neurology – from transient consciousness disturbances to focal deficits, acute muscular disorders, respiratory insufficiency in neurological disorders, headaches, delirium, seizures and epileptic status, para-and tetraplegia, and head trauma, to acute functional disorders – and includes tables and figures to allow readers to gain a quick and easy, yet comprehensive overview of the topic. The book guides readers through various scenarios generated by the onset of symptoms, the clinical tools for differential diagnostics, and the principles of acute and post-acute phase therapy, managed by decision algorithms supported by the most recent scientific evidence. The resulting precedural profile – created through the collaboration of over 80 specialists in neurology or other disciplines – makes this text a valuable tool for neurologists, neurology residents and allied professionals in their daily clinical practice, as well as medical students.

Published
2021

27. Intravenous thrombolysis in stroke patients taking novel oral anticoagulants: experience with the low-dose 0.6 mg/kg of recombinant tissue-type plasminogen activator. Case reports

Author

Franco Galati, Laura Giofrè, Massimiliano Plastino, Domenico Bosco, Arturo Consoli, Antonietta Fava, Paolo Postorino, Domenico Consoli, and Dario Cristiano

Subjects
Stroke patient, business.industry, medicine.medical_treatment, Low dose, Thrombolysis, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Neurology, law, Anesthesia, Ischemic stroke, Recombinant DNA, Medicine, Tissue type, Neurology (clinical), business, Plasminogen activator, 030217 neurology & neurosurgery
Published
2018
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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
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30. Prevenzione delle malattie cerebrovascolari lungo il corso della vita

Author

Bella, Rita, Paolo, Bellisario, Elena, Bozzola, Mauro, Bozzola, Antonio, Carolei, Domenico, Consoli, Claudio, Ferri, Giovanni, Forleo, Daniela, Galeone, Gianfranco, Gensini, Ignazio, Grattagliano, Giovanna, Laurendi, Claudio, Maffeis, Maurizio, Mancuso, Walter, Marrocco, Giuseppe, Micieli, Pietro Amedeo Modesti, Francesca Romana Pezzella, Cecilia, Politi, Leandro, Provinciali, Nicoletta, Reale, Renato Pietro Ricci, Stefano, Ricci, Giancarlo, Roscio, Lidia Rota Vender, Paola, Santalucia, Nicoletta, Scarpa, Alberto, Villani, Augusto, Zaninelli, and Erica, Zaninelli

Published
2019

31. Intravenous thrombolysis in stroke mimics: results from the SITS International Stroke Thrombolysis Register

Author

Anna Peeters, Niaz Ahmed, G. Vanhooren, Paolo Frigio Nichelli, B Keselman, Charith Cooray, Michael V. Mazya, Domenico Consoli, D Sanak, N Wahlgren, P Bassi, Andrea Zini, UCL - SSS/IONS - Institute of NeuroScience, UCL - SSS/IONS/NEUR - Clinical Neuroscience, and UCL - (SLuc) Service de neurologie

Subjects
Male, Stroke management, medicine.medical_treatment, Brain Ischemia, 0302 clinical medicine, Interquartile range, Modified Rankin Scale, Risk Factors, Thrombolytic Therapy, 030212 general & internal medicine, Stroke, Ischaemic stroke, Aged, 80 and over, medicine.diagnostic_test, Thrombolysis, Middle Aged, Diagnostic error, Treatment Outcome, Neurology, Tissue Plasminogen Activator, Cerebral infarct, Cardiology, Administration, Intravenous, Female, Adult, medicine.medical_specialty, Migraine Disorders, Diagnosis, Differential, 03 medical and health sciences, Hematoma, Fibrinolytic Agents, Seizures, Internal medicine, medicine, Humans, Diagnostic Errors, Aged, Cerebral Hemorrhage, Intracerebral hemorrhage, business.industry, Magnetic resonance imaging, medicine.disease, Migraine, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

Background and purpose: Patients with stroke mimics (SM), i.e. conditions with stroke-like symptoms, may risk harm if treated with intravenous thrombolysis (IVT). Current guidelines state low risk of intracerebral hemorrhage based on studies comprising a total of

Published
2019

32. Small Vessel Disease Is Associated with Tissue Inhibitor of Matrix Metalloproteinase-4 After Ischaemic Stroke

Author

Alice Sereni, Anna Maria Gori, Francesco Perini, Giorgio Bono, Rosanna Abbate, Benedetta Piccardi, Francesco Arba, Danilo Toni, Vanessa Palumbo, Francesca Massaro, Enrico Fainardi, Maria Sessa, Giovanni Pracucci, Rossana Tassi, Paolo Bovi, Betti Giusti, Giovanni Orlandi, Antonia Nucera, Mascia Nesi, Domenico Consoli, Domenico Inzitari, and Patrizia Nencini

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Neurology, Time Factors, Tomography Scanners, X-Ray Computed, medicine.medical_treatment, Tissue inhibitor of matrix metalloproteinase, Brain Ischemia, 03 medical and health sciences, 0302 clinical medicine, Atrophy, Bayesian multivariate linear regression, Internal medicine, Medicine, Acute stroke, Humans, Stroke, Aged, Aged, 80 and over, Analysis of Variance, Neuroscience (all), Tissue Inhibitor of Metalloproteinase-1, business.industry, General Neuroscience, Confounding, Leukoaraiosis, Tissue Inhibitor of Metalloproteinases, Thrombolysis, Vascular surgery, Middle Aged, medicine.disease, Small vessel disease, Matrix metalloproteinase, 030104 developmental biology, Cross-Sectional Studies, Italy, Neurology (clinical), Cardiology and Cardiovascular Medicine, Cerebral Small Vessel Diseases, Tissue Plasminogen Activator, Cardiology, Female, business, Tomography, X-Ray Computed, 030217 neurology & neurosurgery
Abstract

Small vessel disease (SVD) is frequent in aging and stroke patients. Inflammation and remodeling of extracellular matrix have been suggested as concurrent mechanisms of SVD. We investigated the relationship between imaging features of SVD and circulating metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in patients with ischaemic stroke. In patients treated with intravenous thrombolysis, we took blood samples before intravenous thrombolysis and 90 days after the acute stroke and analysed levels of MMPs and TIMPs. We assessed leukoaraiosis, number of lacunes and brain atrophy on pre-treatment CT scan and graded global SVD burden combining such features. We investigated associations between single features, global SVD and MMPs and TIMPs at baseline and at follow-up, retaining univariate statistically significant associations in multivariate linear regression analysis and adjusting for clinical confounders. A total of 255 patients [mean (±SD) = 68.6 (± 12.7) years, 154 (59%) males] were included, 107 (42%) had no signs of SVD; 47 (19%) had from moderate to severe SVD burden. A total of 107 (42%) patients had no signs of SVD; 47 (19%) had from moderate to severe SVD burden. After adjustment, only TIMP-4 proved associations with SVD features. Brain atrophy was associated with baseline TIMP-4 (β = 0.20;p = 0.019) and leukoaraiosis with 90 days TIMP-4 (β = 0.19; p = 0.013). Global SVD score was not associated with baseline TIMP-4 levels (β = 0.10; p = 0.072), whereas was associated with 90 days TIMP-4 levels (β = 0.21; p = 0.003). Total SVD burden was associated with higher TIMP-4 levels 90 days after stroke, whereas was not during the acute phase. Our results support a biological relationship between SVD grade and TIMP-4.

Published
2019

33. Do neurologists agree in diagnosing drug resistance in adults with focal epilepsy?

Author

Stefano Meletti, Paolo Tinuper, Angela La Neve, Marco Mula, Maurizio Elia, Leila Zummo, Gaetano Zaccara, Domenico Consoli, Emilio Perucca, Bruno Ferrò, Alfonso Iudice, Anna Teresa Giallonardo, Zaccara G., Mula M., Ferro B., Consoli D., Elia M., Giallonardo A.T., Iudice A., La Neve A., Meletti S., Tinuper P., Zummo L., and Perucca E.

Subjects
Adult, Male, 0301 basic medicine, Drug Resistant Epilepsy, medicine.medical_specialty, Pediatrics, Neurology, Attitude of Health Personnel, Treatment outcome, antiepileptic drugs, classification, drug-resistant epilepsy, epilepsy, ILAE definition, reliability, Neurology (clinical), Drug resistance, 03 medical and health sciences, Epilepsy, antiepileptic drug, 0302 clinical medicine, medicine, Humans, Neurologists, Prospective Studies, Cooperative Behavior, business.industry, Middle Aged, medicine.disease, Confidence interval, Inter-rater reliability, 030104 developmental biology, Anticonvulsants, Female, Epilepsies, Partial, business, 030217 neurology & neurosurgery, Kappa
Abstract

Objective: To evaluate interrater agreement in categorizing treatment outcomes and drug responsiveness status according to the International League Against Epilepsy (ILAE) definition of drug-resistant epilepsy. Methods: A total of 1053 adults with focal epilepsy considered by the investigators to meet ILAE criteria for drug resistance were enrolled consecutively at 43 centers and followed up prospectively for 18-34months. Treatment outcomes for all antiepileptic drugs (AEDs) used up to enrollment (retrospective assessment), and on an AED newly introduced at enrollment, were categorized by individual investigators and by 2 rotating members of a 16-member expert panel (EP) that reviewed the patient records independently. Interrater agreement was tested by Cohen’s kappa (k) statistics and rated according to Landis and Koch’s criteria. Results: Agreement between EP members in categorizing outcomes on the newly introduced AED was almost perfect (90.1%, k=0.84, 95% confidence interval [CI] 0.80-0.87), whereas agreement between the EP and individual investigators was moderate (70.4%, k=0.57, 95% CI 0.53-0.61). Similarly, categorization of outcomes on previously used AEDs was almost perfect between EP members (91.7%, k=0.83, 95% CI 0.81-0.84) and moderate between the EP and investigators (68.2%, k=0.50, 95% CI 0.48-0.52). Disagreement was related predominantly to outcomes considered to be treatment failures by the investigators but categorized as undetermined by the EP. Overall, 19% of patients classified as having drug-resistant epilepsy by the investigators were considered by the EP to have “undefined responsiveness.”. Significance: Interrater agreement in categorizing treatment outcomes according to ILAE criteria ranges from moderate to almost perfect. Nearly 1 in 5 patients considered by enrolling neurologists to be “drug-resistant” were classified by the EP as having “undefined responsiveness.”.

Published
2019

34. 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

35. 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

36. Prevalence of atrial fibrillation in the Italian elderly population and projections from 2020 to 2060 for Italy and the European Union: the FAI Project

Author

Augusto Zaninelli, Maria Grazia D'Alfonso, Bruno Sgherzi, Biancamaria Polizzi, Alessandro Cattarinussi, Domenico Consoli, Domenico Inzitari, Leonardo Bellino, Antonio Di Carlo, Giovanni Pracucci, Fabio Mori, Marzia Baldereschi, Benedetta Piccardi, and Chiara Gradia

Subjects
Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, 03 medical and health sciences, Electrocardiography, 0302 clinical medicine, Age Distribution, Physiology (medical), Elderly population, Epidemiology, Atrial Fibrillation, medicine, Prevalence, media_common.cataloged_instance, Humans, Mass Screening, 030212 general & internal medicine, European Union, Prospective Studies, European union, Sex Distribution, Stroke, Opportunistic screening, media_common, Aged, business.industry, Age Factors, Mean age, Atrial fibrillation, medicine.disease, Confidence interval, Cross-Sectional Studies, Italy, Female, Cardiology and Cardiovascular Medicine, business, Demography, Follow-Up Studies, Forecasting
Abstract

Aims To estimate prevalence of atrial fibrillation (AF) in a representative sample of the Italian elderly population, projecting figures for Italy and the European Union. Methods and results A cross-sectional examination of all subjects aged 65+ years from three general practices in Northern, Central, and Southern Italy started in 2016. Participants were administered a systematic and an opportunistic screening, followed by clinical and electrocardiogram confirmation. The study sample included 6016 subjects. Excluding 235 non-eligible, among the remaining 5781 participation was 78.3%, which left 4528 participants (mean age 74.5 ± 6.8 years, 47.2% men). Prevalence of AF was 7.3% [95% confidence intervals (CI) 6.6–8.1], higher in men and with advancing age (6.6% from systematic plus 0.7% from opportunistic screening). Using prevalence figures, Italian elderly having AF in 2016 were estimated at ∼1 081 000 (95% CI 786 000–1 482 000). Considering stable prevalence, this number will increase by 75% to ∼1 892 000 in 2060 (95% CI 1 378 000–2 579 000). European Union elderly having AF in 2016 were estimated at ∼7 617 000 (95% CI 5 530 000–10 460 000), increasing by 89% to ∼14 401 000 in 2060 (95% CI 10 489 000–19 647 000). In 2016, subjects aged 80+ years represented 53.5% of cases in Italy and 51.2% in the European Union; in 2060, 69.6% and 65.2%, respectively. Conclusions Our findings indicate a high burden of AF in coming decades, especially among the oldest-old, who carry the higher AF-related risk of stroke and medical complications.

Published
2018

37. Validated outcome of treatment changes according to International League Against Epilepsy criteria in adults with drug-resistant focal epilepsy

Author

Marco Mula, Gaetano Zaccara, Carlo Andrea Galimberti, Bruno Ferrò, Maria Paola Canevini, Addolorata Mascia, Oriano Mecarelli, Roberto Michelucci, Laura Rosa Pisani, Luigi Maria Specchio, Salvatore Striano, Emilio Perucca, Cristina Valisi, Francesco Paladin, Filippo Dainese, Roberto Eleopra, Christian Lettieri, Giada Pauletto, Tiziano Zanoni, Monica Ferlisi, Francesco Pierini, Federica Ranzato, Teressa Anna Cantisani, Chiara Piersanti, Federica Nardini, Michela Cecconi, Nicoletta Foschi, Chiara Fiori, Cristina Petrelli, Raffaele Rocchi, Lorenzo Celli, Daniela Marino, Paolo Aloisi, Alfonso Iudice, Emanuele Bartolini, Marco Paganini, Anna Maria Romoli, Francesca Pizzo, Tramacere Luciana, Angela La Neve, Teresa Francavilla, Marianna Ladogana, Nicola Paciello, Giovanni Boero, Maria Grazia Pascarella, Anna Teresa Giallonardo, Jiinane Fattouch, Sara Casciato, Patrizia Pulitano, Alessia Zarabla, Michele Feleppa, Maria Rosaria D'Argento, Francesco Habetswallner, Bernardo De Martino, Amelia Cutolo, Maria Grazia Marciani, Andrea Romigi, Maria Albanese, Marta Ianniciello, Marianna De Vito, Luigi Del Gaudio, Silvana Franceschetti, Davide Sebastiano Rossi, Flavio Villani, Giuseppe Didato, Fabio Minicucci, Emanuela Leopizzi, Stefano Meletti, Laura Mirandola, Giada Giovannini, Roberto Micheluzzi, Patrizia Riguzzi, Paolo Tinuper, Barbara Mostacci, Marcella Broli, Giulia Scornavacca, Gianpietro Sechi, Silia Fenu, Chiara Fois, Francesco Marrosu, Gianni Orofino, Vito Sofia, Irene Pappalardo, Chiara Sueri, Loretta Giuliano, Ornella Daniele, Leila Zummo, Francesco Pisani, Giuseppe Loddo, Cesare Stilo, Umberto Aguglia, Cinzia Leonardi, Edoardo Ferlazzo, null Bellavia, Domenico Consoli, Caterina Gattuso, Maurizio Elia, Maria Grazia Figura, Gianadrea Ottonello, Daniela Arecco, Antonio Gambardella, Maria Pantusa, Fabrizio Monti, Marco Belluzzo, Marinella Tomaselli, Luigi Giuseppe Bongiovanni, Francesco Brigo, Paola Banfi, and Valeria Mariani

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Drug Resistant Epilepsy, Adolescent, Drug resistance, Outcome (game theory), 03 medical and health sciences, Epilepsy, Young Adult, drug-resistant epilepsy, 0302 clinical medicine, Internal medicine, drug‐resistant epilepsy, medicine, Humans, In patient, Prospective Studies, antiepileptic drugs, Prospective cohort study, Aged, Aged, 80 and over, treatment, business.industry, Reproducibility of Results, Middle Aged, medicine.disease, epilepsy, outcome, 030104 developmental biology, Treatment Outcome, Neurology, Full‐length Original Research, Observational study, Anticonvulsants, Female, Neurology (clinical), Epilepsies, Partial, business, International league against epilepsy, 030217 neurology & neurosurgery
Abstract

Summary Objective Although many studies have attempted to describe treatment outcomes in patients with drug‐resistant epilepsy, results are often limited by the adoption of nonhomogeneous criteria and different definitions of seizure freedom. We sought to evaluate treatment outcomes with a newly administered antiepileptic drug (AED) in a large population of adults with drug‐resistant focal epilepsy according to the International League Against Epilepsy (ILAE) outcome criteria. Methods This is a multicenter, observational, prospective study of 1053 patients with focal epilepsy diagnosed as drug‐resistant by the investigators. Patients were assessed at baseline and 6, 12, and 18 months, for up to a maximum of 34 months after introducing another AED into their treatment regimen. Drug resistance status and treatment outcomes were rated according to ILAE criteria by the investigators and by at least two independent members of an external expert panel (EP). Results A seizure‐free outcome after a newly administered AED according to ILAE criteria ranged from 11.8% after two failed drugs to 2.6% for more than six failures. Significantly fewer patients were rated by the EP as having a “treatment failure” as compared to the judgment of the investigator (46.7% vs 62.9%, P

Published
2018

38. Italian census on neurosciences. the icone 2 study

Author

Salvatore Mangiafico, Francesco Galati, Franco Galati, Domenico Consoli, Giovanni Carbotta, Danilo Toni, Giovanni Franco, Giuseppe Micieli, Bruno Zanotti, Arturo Consoli, and Paolo Postorino

Subjects
Adult, Male, medicine.medical_specialty, Demographics, Dermatology, neuroscience, 03 medical and health sciences, 0302 clinical medicine, demographics, Radiologists, Humans, Medicine, training programs, Neurologists, 030212 general & internal medicine, Acute ischemic stroke, model, business.industry, General Medicine, Middle Aged, Census, organization, Mechanical thrombectomy, Psychiatry and Mental health, Cross-Sectional Studies, Neurosurgeons, Italy, Family medicine, Female, Neurology (clinical), business, 030217 neurology & neurosurgery
Abstract

The growing impact of the emergency neurology of trauma centers and of mechanical thrombectomy for the treatment of acute ischemic stroke is revolutionizing the domain of eurosciences. A census focused on the demographic distribution of the three main cohorts of neurosciences (neurologists, neuroradiologists, and neurosurgeons) was conducted in Italy between December 2015 and February 2017, and results were compared to the estimated retirement rates and loss for other reasons. The total number of neurosciences specialists active in Italy was 4394 at the end of the period of the survey. The estimated retirement rates and losses seem not be supplied by the physicians in training in the same period. A proper redistribution of the resources and the modification of the training programs seem to be mandatory to maintain acceptable standards of care for the Italian neurosciences during the next decade.

Published
2018

39. Un framework integrato per la misura dell'innovazione del Piano Nazionale Scuola Digitale (PNSD)

Author

Selena Aureli, Domenico Consoli, Consoli, Domenico, and Aureli, Selena

Subjects
Government, Engineering management, Political science, Control (management), Virtual learning environment, Strategic management, Context (language use), Plan (drawing), Space (commercial competition), Investment (macroeconomics), PNSD, digital school, indicators, performance, innovation, BSC, EFQM
Abstract

The National Plan for Digital School (PNSD) is a fundamental pillar of the Good School Reform (Law no. 107/2015), which reflects the Government's position re-spect to most important challenges of the innovation in public schools. The Plan is focused on the strengthening of digital skills and on the extension of the concept of the school from physical location to virtual learning space where the teaching and the planning can be made anywhere. The Plan has a long-term value and it traces the guidelines of the future school towards a path of innovation and digitalization. In this context of change of the Digital Society it is essential to introduce managerial models that help schools to develop competences in strategic management control useful to plan and monitor the investment in digital technologies. The paper presents an integrated framework that analyses and measures the innovation introduced by the PNSD and its performance through appropriate indicators and measurement tools.

Published
2018

40. ICT e piccole imprese. Il Cubo della Predisposizione Tecnologica Aziendale

Author

Francesca Maria Cesaroni and Domenico Consoli

Subjects
Process management (computing), Business data, Knowledge management, Commerce, Web 2.0, business.industry, Process (engineering), Information and Communications Technology, Order (exchange), Control (management), Position (finance), business
Abstract

The ability to use ICT to handle, process and use business data, as well as to develop new tools to support process management and control functions, is an essential condition for small businesses’ competitiveness. Important differences in ICT adoption rates between large and small firms have been identified, but it is important to properly assess the technological position of small businesses (SB), in order to reflect different ICT development paths. For this reason this paper presents a three-dimensional assessment framework - named Cube of the Corporate Technological Level (CCTL) - which allows evaluating businesses’ technological position using three different dimensions. Some case studies are briefly described in order to illustrate the ability of the model to reflect differences between enterprises with different technological positions. This tool enables companies to properly assess their technological position as well as their potential and existing weaknesses. It also allows choosing future ICT investments, as it can help to outline the path to follow for reaching a position of optimum technological development.

Published
2015
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41. Risk for Major Bleeding in Patients Receiving Ticagrelor Compared With Aspirin After Transient Ischemic Attack or Acute Ischemic Stroke in the SOCRATES Study (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes)

Author

J. Donald Easton, Maria Aunes, Gregory W. Albers, Pierre Amarenco, Sara Bokelund-Singh, Hans Denison, Scott R. Evans, Peter Held, Marianne Jahreskog, Jenny Jonasson, Kazuo Minematsu, Carlos A. Molina, Yongjun Wang, K.S. Lawrence Wong, S. Claiborne Johnston, Sebastiá F. Ameriso, Geoffrey Donnan, Robin Lemmens, Ayrton Massaro, Ekaterina Titianova, Michael D. Hill, Pablo Lavados, David Skoloudik, Joachim Röther, Szegedi Norbert, Giancarlo Agnelli, Natan Bornstein, Norio Tanahashi, Angel Arauz Góngora, Edwin Pretell, Maria Cristina Z. San Jose, Anna Czlonkowska, Ovidiu Bajenaru, Ludmila Stakhovskaya, Miroslav Brozman, Jong-Sung Kim, Nils Wahlgren, Patrik Michel, Tsong Hai Lee, Nijasri Charnnarong Suwanwela, Kursad Kutluk, Sergii Moskovko, Scott Kasner, Daniel Laskowitz, Wayne Clark, Huy Thang Nguyen, Sebastian Ameriso, Sandra Lepera, Marina Romano, David Paulon, Pablo Ioli, Cristina Zurru, Guadalupe Bruera, Lorena Jure, Francisco Klein, Guillermo Povedano, Christopher Levi, Thanh Phan, Romesh Markus, Craig Anderson, Arman Sabet, Stephen Davis, Andrew Lee, Timothy Kleinig, Andrew Wong, Martin Krause, Jim Jannes, Tissa Wijeratne, Dimitri Hemelsoet, André Peeters, Philippe Tack, Peter Vanacker, Patrice Laloux, William Van Landegem, Geert Vanhooren, Philippe Desfontaines, Marc Van Orshoven, Fabio Oliveira, Mauricio Friedrich, Rosane Brondani, Rubens Gagliardi, Soraia Fabio, Marianna Dracoulakis, Rodrigo Bazan, Luiz Marrone, Octavio Pontes Neto, Gisele Silva, Pedro Kowacs, Paraskeva Stamenova, Marin Daskalov, Ivan Staikov, Dimo Baldaranov, Dimitar Maslarov, Hristo Lilovski, Plamen Petkov, Neli Petrova, Radoslav Mavrov, Veska Markova, Valeria Petrova, Tanya Beleva, Borislav Kralev, Nikolay Sotirov, Veska Lekova, Dimcho Hristov, Vera Ermenkova, Lyudmil Mateev, Rumeliya Mitkova, Liybomir Haralanov, Rosen Ikonomov, Margarita Mihailova, Ivan Georgiev, Ashfaq Shuaib, Vladimir Hachinski, Jean-Martin Boulanger, Sharan Mann, Ayman Hassan, Ariane Mackey, Bijoy Menon, Jeffrey Minuk, Muzaffar Siddiqui, Marsha Eustace, Lucia Vieira, Daniel Selchen, Michel Beaudry, Grant Stotts, Angel Castro, Kristo Gasic, Rodrigo Rivas, Pablo Sanchez, Andres Roldan, Ingrid Grossmann, Christian Figueroa, Jimei Li, Xiaolin Xu, Huisheng Chen, Xiaohong Li, Yi Yang, Chunsheng Zhang, Baojun Wang, Guanglai Li, Dong Wang, Hong Lin, Yamei Tang, Anding Xu, Yanjiang Wang, Wenke Hong, Zhi Song, Xu Zhang, Xiaoping Jin, Yun Xu, Fuling Yan, Weihong Zheng, Xiaoping Wang, Qiang Dong, Zhongxin Zhao, Baorong Zhang, Wangtao Zhong, Guoqiang Wen, Jun Xu, Guozhong Li, Xueshuang Dong, Xiangyang Tian, Zhaohui Zhang, En Xu, Kaixiang Liu, Jun Chen, Ondrej Skoda, Edvard Ehler, Daniel Vaclavik, Daniel Sanak, Sylva Klimosova, Eva Vitkova, Jan Fiksa, Robert Mikulik, Jiri Neumann, Richard Plny, Didier Leys, Igor Sibon, Jean-Louis Mas, Sonia Alamowitch, Fernando Pico, Hassan Hosseini, Marie-Hélène Mahagne, Emmanuel Touze, Wilfried Vadot, Stéphane Vannier, Norbert Nighoghossian, Yves Samson, Pierre Garnier, Emmanuel Ellie, Benoît Guillon, Serge Timsit, Maurice Giroud, Frédéric Philippeau, Aude Bagan-Triquenot, Valérie Wolff, Nicolas Raposo, Michel Obadia, Severine Debiais, Jérôme Grimaud, Stéphane Illouz, Didier Smadja, Cédric Urbanczyk, Jörg Berrouschot, Christian Weimar, Georg Gahn, Hassan Soda, Sven Klimpe, Darius Nabavi, Jörg Glahn, Martin Köhrmann, Lars Krause, Christoph Terborg, Peter Urban, Thorsten Steiner, Andreas Ferbert, Rainer Dziewas, Günter Seidel, Götz Thomalla, Richard Li, Wing Chi Fong, Raymond Cheung, Norbert Szegedi, Krisztián Pozsegovits, Attila Valikovics, Gyula Pánczél, Csilla Rózsa, László Németh, Péter Diószeghy, Csaba Óváry, Attila Csányi, Levente Kerényi, Valéria Nagy, Sámuel Komoly, Dániel Bereczki, Sándor Molnár, István Kondákor, David Tanne, Guy Raphaeli, Gregory Telman, Ronen Leker, Yair Lampl, Francesco Corea, Stefano Ricci, Donata Guidetti, Giovanni Malferrari, Simona Marcheselli, Giuseppe Micieli, Andrea Zini, Vincenzo Di Lazzaro, Carlo Gandolfo, Andrea Salmaggi, Rossana Tassi, Maurizia Rasura, Giovanni Orlandi, Giancarlo Comi, Michelangelo Mancuso, Marialuisa Delodovici, Paolo Bovi, Domenico Consoli, Kimiaki Utsugisawa, Tsuneo Fujita, Hideyuki Kurihara, Chikashi Maruki, Takeshi Hayashi, Tsuneaki Ogiichi, Morio Kumagai, Katsunobu Takenaka, Kazunori Toyoda, Kazuhiro Takamatsu, Ryo Ogami, Shigenari Kin, Takeshi Aoki, Katsumi Takizawa, Shigehiro Omori, Takehiko Umezawa, Yasuyuki Toba, Yutaka Nonoyama, Hidemitsu Nakagawa, Takashi Naka, Masanori Morimoto, Shuichi Matsumoto, Tsutomu Hitotsumatsu, Tatsuya Shingaki, Satoshi Okuda, Mamoru Ota, Nobuyuki Sakai, Takeshi Yamada, Jun Niwa, Hitoshi Fujita, Akihito Moriki, Kimihiro Yoshino, Yoshihisa Fukushima, Takahisa Mori, Atsushi Sato, Yoshikazu Kusano, Michiya Kubo, Masashi Yamazaki, Takao Ooasa, Takafumi Nishizaki, Naoki Kitagawa, Masahiro Yasaka, Yasuhiro Manabe, Akira Yoshioka, Masayuki Ishihara, Takato Kagawa, Toshikazu Ichihashi, Hideki Matsuoka, Yasuhiro Ito, Masahiro Yamasaki, Hitonori Takaba, Hisatoshi Saito, Masahiro Sato, Kazumasa Fukuda, Sumio Endo, Minoru Kidooka, Toshitaka Umemura, Yuriko Kikkawa, Shuta Toru, Kentaro Yamada, Hideki Sakai, Jun Asari, Masayuki Ezura, Hisashi Nitta, Keiko Nagano, Jun Ochiai, Keiichi Sakai, Yasutaka Kobayashi, Yasuhiro Yoshii, Hirotomo Miake, Tomohiro Takita, Hidekazu Taniguchi, Kazuhiko Kuroki, Takamitsu Mizota, Kenichi Yamamoto, Hiroshi Nakane, Takeshi Iwanaga, Kei Chiba, Tetsuyuki Yoshimoto, Tsuyoshi Torii, Takeo Kitagawa, Hiroshi Takashima, Naoki Shirasaki, Makoto Dehara, Naomichi Wada, Kensuke Hamada, Noriyuki Kato, Yoshinori Go, Ichiro Izumi, Hirotomo Ninomiya, Junichiro Kumai, Yoshikazu Nakajima, Yasuhiko Kaku, Yukihiro Isayama, Masahiro Kawanishi, Shinya Noda, Kazuhide Yamamoto, Takanori Hazama, Hiroshi Takahashi, Yohei Tanaka, Takashi Hata, Kiyoshi Kazekawa, Eisuke Furui, Hideki Hondo, Nobuyuki Sato, Katsusuke Kusunoki, Kazunori Nanri, Satoshi Abe, Noboru Sasaoka, Takayuki Kuroyanagi, Hisahiko Suzuki, Kouzou Fukuyama, Kimihiro Nakahara, Fernando Gongora, Carlos Cantú Brito, Jorge Villarreal Careaga, Rosalia Vazquez Alfaro, Geronimo Aguayo Leytte, Percy Berrospi, Carlos Chavez, Liliana Rodriguez, Nilton Custodio, Cesar Castañeda, Julio Perez, Maria Cristina San Jose, Alejandro Baroque, Epifania Collantes, Abdias Aquino, Alejandro Díaz, Artemio Roxas, Johnny Lokin, Joel Advincula, Emerito Calderon, Jose Navarro, John Hiyadan, Arturo Surdilla, Danuta Ryglewicz, Grzegorz Krychowiak, Waldemar Fryze, Piotr Sobolewski, Ryszard Nowak, Urszula Fiszer, Beata Papierowska, Justyna Zielińska-Turek, Anetta Lasek-Bal, Ewa Kołodziejska, Anna Kamińska, Bożena Adamkiewicz, Andrzej Tutaj, Dorota Szkopek, Krzysztof Musiatowicz, Zbigniew Bąk, Sławomir Brzozowski, Waldemar Brola, Antoni Ferens, Marek Zalisz, Konrad Rejdak, Monika Rudzińska, Cristina Panea, Mihaela Simu, Rodica Balasa, Iulian Cuciureanu, Bogdan Popescu, Monica Sabau, Corina Roman-Filip, Leonid Pimenov, Alla Gekht, Anna Milto, Ivan Shchukin, Vladimir Parfenov, Liudmila Stakhovskaya, Mikhail Arkhipov, Nadezhda Sokolova, Enver Bogdanov, Radiy Esin, Dina Khasanova, Konstantin Golikov, Elena Melnikova, Leonid Zaslavskiy, Igor Voznyuk, Alexander Nazarov, Leila Akhmadeeva, Aida Iakupova, Nikolay Shamalov, Galina Belskaya, Svetlana Chuprina, Olga Denisova, Ekaterina Drozdova, Yuliya Karakulova, Ilya Sholomov, Nikolay Spirin, Elena Vostrikova, Elena Mordvintseva, Vera Grigoryeva, Dmitry Zateyshchikov, Vladimir Gorbachev, Zhanna Chefranova, Mikhail Dudarev, Rostislav Nilk, Alexey Rozhdestvenskiy, Ladislav Gurcik, Miloslav Dvorak, Georgi Krastev, Egon Kurca, Juraj Vyletelka, Jong Sung Kim, Hee-Joon Bae, Yong-Won Kim, Joon-Tae Kim, Jae-Kwan Cha, Hyo Suk Nam, Dae-Il Chang, Yong-Seok Lee, Kyungmi Oh, Sung-Wook Yu, Sung-Il Sohn, Jun Lee, Han Jin Cho, Eung-Gyu Kim, Joung-Ho Rha, Seo Hyun Kim, Carlos Molina Cateriano, Joaquín Serena Leal, José Vivancos Mora, Manuel Rodríguez Yañez, Jaume Roquer González, Francisco Purroy García, Meritxell Gomis Cortina, Jaime Masjuan Vallejo, Juan Arenillas Lara, Tomás Segura Martín, José Antonio Egido Herrero, Jose Ignacio Tembl Ferrairó, Jaime Gállego Culleré, Francisco Moniche Álvarez, Anna Steinberg, Margarita Callander, Ann Charlotte Laska, Lena Bokemark, Thomas Mooe, Tor-Björn Käll, Lennart Welin, Lars Sjöblom, Joakim Hambraeus, Jörg Teichert, Hans Wannberg, Johan Sanner, Bo Ramströmer, Bo Ziedén, Stefan Olsson Hau, Claes Gustafsson, Timo Kahles, Philippe Lyrer, Marcel Arnold, Martin Liesch, Friedrich Medlin, Carlo Cereda, Georg Kägi, Andreas Luft, Emmanuel Carrera, Tsong-Hai Lee, Helen L. Po, Chang-Ming Chern, Li-Ming Lien, Lung Chan, Chung-Hsiang Liu, Shey-Lin Wu, Jiann-Der Lee, Chih-Hung Chen, Huey-Juan Lin, Ruey-Tay Lin, Wei-Hsi Chen, Yu Sun, Tasanee Tantirittisak, Sombat Muengtaweepongsa, Yongchai Nilanont, Somsak Tiamkao, Chesda Udommongkol, Kanokwan Watcharasaksilp, Witoon Jantararotai, Hadiye Sirin, Birsen Ince, Talip Asil, Murat Arsava, Tulay Kurt Incesu, Hulya Tireli, Hayriye Kucukoglu, Fikri Ak, Ali Unal, Serefnur Ozturk, Nevzat Uzuner, Galyna Chmyr, Volodymyr Lebedynets, Vadym Nikonov, Lyudmyla Shulga, Volodymyr Smolanka, Marta Khavunka, Valentyna Yavorska, Nataliya Tomakh, Olexandr Kozyolkin, Galyna Litovaltseva, Maarten Lansberg, Richard Bernstein, David Brown, Jonathan Dissin, Carmelo Graffagnino, Jonathan Harris, William Hicks, Irene Katzan, Jeffrey Kramer, Joshua Willey, Scott Silliman, Sidney Starkman, David Thaler, Margaret Tremwel, Mauricio Concha, Kumar Rajamani, Bhuvaneswari Dandapani, Brian Silver, Nathan Deal, Ira Chang, Ameer Hassan, Steven Rudolph, Kenneth Fischer, Howard Kirshner, William Logan, Sidney Mallenbaum, Hebah Hefzy, Julius Latorre, Steven Levine, Anthony Ciabarra, Rima Dafer, Benjamin Anyanwu, Laurel Cherian, Spozhmy Panezai, Anna Khanna, Jodi Dodds, Michel Torbey, James Gebel, Henry Woo, David Chiu, Xiao Androulakis, William Burgin, Maria Pineda, Engin Yilmaz, Irfan Altafullah, Christine Boutwell, Salvador Cruz-Flores, Biggya Sapkota, Pierre Fayad, Michael Jacoby, Shahid Rafiq, Efrain Salgado, Eugene Lafranchise, Warren Felton, Ramesh Madhavan, Osama Zaidat, Connie Pieper, Ralph Riviello, Aaron Burnett, Michelle Fischer, Nina Gentile, Christopher Calder, Dennis Dietrich, Jonathan Cross, Larry Blankenship, Liliana Montoya, Wendell Grogan, Mark Young, Farrukh Khan, Duane Campbell, Nizar Daboul, Andrey Espinoza, Paul Cullis, Gilberto Concepcion, John Wulff, Haider Afzal, Naseem Jaffrani, William Reiter, Tamjeed Arshad, Timothy Lukovits, James Welker, Fen Lei Chang, Aamir Badruddin, Viken Babikian, Ravi Menon, James Sander, Mellanie Springer, Ashish Nanda, Luis Mas, Raj Rajan, Bruce Silverman, David Huang, David Carpenter, Joni Clark, Marilou Ching, Sunitha Santhakumar, Jeffrey Gould, Vibhav Bansal, Gabriel Vidal, Timothy Mikesell, John Brick, William French, Qaisar Shah, Christine Holmstedt, Nadir Ishag-Osman, John Kostis, Abbas Shehadeh, Pramodkumak Sethi, Asher Imam, Carl Mccomas, Duc Tran, Mehari Gebreyohanns, Brian Wiseman, Maheen Malik, Aron Schwarcz, Dorothea Altschul, John Castaldo, Amer Alshekhlee, Stephen Gancher, Nagesh Krish, Mai Nguyen-Huynh, Margaret Tremwell, Jitendra Sharma, Lance Lee, William Neil, Fazeel Siddiqui, Ali Malek, Charles Romero, Thang Nguyen Huy, Hoa Hoang, Thang Nguyen, Anh Nguyen, Hung Nguyen, Laboratoire de Recherche Vasculaire Translationnelle ( LVTS ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), AstraZeneca, National Cerebral and Cardiovascular Center ( NCCC - OSAKA ), Osaka University [Osaka], Department of Neurology ( Dep Neuro - BEIJING ), Tiantan Hospital, University of Melbourne, Faculty of Mathematics and Statistics, Ton Duc Thang University, Ho Chi Minh City, Heidelberg University, Centre hospitalier de Namur, IBM Thomas J. Watson Research Center, IBM, Bulgarian Academy of Sciences, Department of Clinical Neurological Sciences [London, Canada], University of Western Ontario ( UWO ), Servicio de Neurologia ( SANTIAGO - Neurologie ), Universidad de Santiago de Chile [Santiago] ( USACH ) -Universidad del Desarrollo, Institut de Chimie de Clermont-Ferrand - Clermont Auvergne ( ICCF ), Sigma CLERMONT ( Sigma CLERMONT ) -Université Clermont Auvergne ( UCA ) -Centre National de la Recherche Scientifique ( CNRS ), Universidad de Talca, Shanghai Second Polytechnic University, Northwest Normal University [Lanzhou], Zhongda Hospital, Southeast University [Jiangsu], Cryogenics Laboratory ( CRYOGENICS LABORATORY ), Huazhong University of Science and Technology [Wuhan] ( HUST ) -Wuhan University [China], Centre for Synthetic and Systems Biology, University of Edinburgh-School of Biological Sciences, Duke university [Durham], Fiber Glass, Glass Business and Discovery Center, PPG Industries, National University of Defense Technology [Changsha], School of Oceanography [Seattle], University of Washington [Seattle], Key Laboratory of New Processing Technology for Nonferrous Metals and Materials, Guilin University of Technologie, Laboratoire de Génie Electrique et Ferroélectricité ( LGEF ), Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ) -Université de Lyon-Institut National des Sciences Appliquées ( INSA ), Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Université de Bordeaux ( UB ), Service de Pédiatrie, Centre Hospitalier Universitaire de Nice ( CHU Nice ) -Hôpital l'Archet, Université Pierre et Marie Curie - Paris 6 ( UPMC ), Centre Hospitalier de Versailles ( CHV ), Service de neurologie, Hôpital Sainte-Anne, Functional Exploration of Nervous, CHU Grenoble, Service de Neurologie [Rennes], Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière ( NEMESIS-CRICM ), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière ( CRICM ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Institut Français de Mécanique Avancée ( IFMA ), Neurologie - Côte Basque ( NEUROLOGIE ), Hopital, Laboratoire d'Intégration des Systèmes et des Technologies ( LIST ), Université Paris-Saclay-Direction de Recherche Technologique (CEA) ( DRT (CEA) ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) ( GGB ), Institut Brestois Santé Agro Matière ( IBSAM ), Université de Brest ( UBO ) -Université de Brest ( UBO ) -EFS-Institut National de la Santé et de la Recherche Médicale ( INSERM ), CIC Brest, Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hôpital de la Cavale Blanche, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), CHU Strasbourg, Imagerie cérébrale et handicaps neurologiques, Institut des sciences du cerveau de Toulouse. ( ISCT ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès ( UT2J ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès ( UT2J ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Department of Neurology, Asklepios Klinik Altona, Department of Neurology and Stroke Center, Universität Duisburg-Essen [Essen], Department of Neurology, University of Mainz, Vivantes Klinikum Neukölln, University of Erlangen, University Hospital Münster, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] ( UKE ), PROTOMED, Neurology Department, Ichilov Medical Center, Internal and Cardiovascular Medicine - Stroke Unit ( PERUGIA - ICM-SU ), Università degli Studi di Perugia ( UNIPG ), University Hospital San Raffaele Milan, Scientific Institute and University Ospedale San Raffaele, Dipartimento di Scienze Fisiche, della Terra e dell'Ambiente., Università degli Studi di Siena ( UNISI ), Department of Education, Yamagata University, Nippon Medical School, Catalan Institute of Ornithology (ICO), Museu de Ciències Naturals (Zoologia), Wroclaw University of Science and Technology, Department of neurology, Jagiellonian University [Krakow] ( UJ ), LInguistique et DIdactique des Langues Étrangères et Maternelles ( LIDILEM ), Université Stendhal - Grenoble 3-Université Grenoble Alpes ( UGA ), Metacohorts Consortium, GenXpro GmBH, Lausanne University Hospital, Lausanne university hospital, Northeastern University [Boston], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), National Cerebral and Cardiovascular Center (NCCC - OSAKA), Department of Neurology (Dep Neuro - BEIJING), Bulgarian Academy of Sciences (BAS), University of Western Ontario (UWO), Servicio de Neurologia (SANTIAGO - Neurologie), Universidad del Desarrollo, Institut de Chimie de Clermont-Ferrand (ICCF), SIGMA Clermont (SIGMA Clermont)-Institut de Chimie du CNRS (INC)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), Shanghai Polytechnic University (SSPU), Cryogenics Laboratory (CRYOGENICS LABORATORY), Huazhong University of Science and Technology [Wuhan] (HUST)-Wuhan University [China], Centre for Synthetic and Systems Biology (Ssynthsys), University of Edinburgh, Duke University [Durham], National University of Defense Technology [China], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Université de Bordeaux (UB), Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Université Pierre et Marie Curie - Paris 6 (UPMC), Centre Hospitalier de Versailles André Mignot (CHV), Service de Neurologie [Rennes] = Neurology [Rennes], CHU Pontchaillou [Rennes], Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière (NEMESIS-CRICM), Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière (CRICM), Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut Français de Mécanique Avancée (IFMA), Neurologie - Côte Basque (NEUROLOGIE), Centre hospitalier universitaire de Nantes (CHU Nantes), Génétique, génomique fonctionnelle et biotechnologies (UMR 1078) (GGB), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-EFS-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), University Hospital Münster - Universitaetsklinikum Muenster [Germany] (UKM), Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Internal and Cardiovascular Medicine - Stroke Unit (PERUGIA - ICM-SU), Università degli Studi di Perugia (UNIPG), Università degli Studi di Siena = University of Siena (UNISI), Uniwersytet Jagielloński w Krakowie = Jagiellonian University (UJ), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Neurologie - Côte Basque, Centre Hospitalier de la Côte Basque (CHCB), EFS-Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Universität Duisburg-Essen = University of Duisburg-Essen [Essen], Università degli Studi di Perugia = University of Perugia (UNIPG), Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-SIGMA Clermont (SIGMA Clermont), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Jagiellonian University [Krakow] (UJ), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Institut National de la Santé et de la Recherche Médicale (INSERM), Weimar, Christian (Beitragende*r), and Calvez, Ghislaine

Subjects
Male, Risk, Ticagrelor, Adenosine, [SDV]Life Sciences [q-bio], Population, Medizin, Hemorrhage, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Platelet aggregation inhibitors, Physiology (medical), [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, medicine, Humans, Myocardial infarction, education, Stroke, ComputingMilieux_MISCELLANEOUS, Aged, Aspirin, Ischemic attack, Transient, Female, Ischemic Attack, Transient, Purinergic P2Y Receptor Antagonists, Treatment Outcome, Cardiology and Cardiovascular Medicine, education.field_of_study, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, [ SDV ] Life Sciences [q-bio], Ischemic Attack, business.industry, medicine.disease, Clopidogrel, [SDV] Life Sciences [q-bio], Anesthesia, Platelet aggregation inhibitor, business, 030217 neurology & neurosurgery, TIMI, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

Background: Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin. The main safety objective was assessment of PLATO (Platelet Inhibition and Patient Outcomes)–defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH). Methods: An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) definitions. The definitions of ICrH and major bleeding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population. Results: A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (hazard ratio, 0.83; 95% confidence interval, 0.52–1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thirteen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symptomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ticagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspirin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor. Conclusions: Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01994720.

Published
2017

42. Inflammatory and metalloproteinases profiles predict three-month poor outcomes in ischemic stroke treated with thrombolysis

Author

Benedetta Piccardi, Maria Rosaria Tola, Francesco Perini, Giovanni Pracucci, Eleonora Innocenti, Rossana Tassi, Danilo Toni, Marialuisa Zedde, Domenico Consoli, Domenico Inzitari, Maria Luisa DeLodovici, Maria Sessa, Paolo Bovi, Anna Maria Gori, Mario Guidotti, Patrizia Nencini, Vanessa Palumbo, Betti Giusti, Mascia Nesi, Rosanna Abbate, Elena Sticchi, Alice Sereni, Giuseppe Micieli, Giovanni Orlandi, Paolina Tonelli, Antonia Nucera, and Francesca Massaro

Subjects
Male, medicine.medical_specialty, thrombolysis, Time Factors, medicine.medical_treatment, Inflammation, 030204 cardiovascular system & hematology, Lesion, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, ischemic stroke, Medicine, Humans, Thrombolytic Therapy, Stroke, Aged, business.industry, Hemorrhagic transformation, inflammation, metalloproteinase, Neurology, Neurology (clinical), Cardiology and Cardiovascular Medicine, Atrial fibrillation, Thrombolysis, Original Articles, medicine.disease, Clinical research, Logistic Models, Treatment Outcome, ROC Curve, Predictive value of tests, Heart failure, Multivariate Analysis, Physical therapy, Cardiology, Metalloproteases, Cytokines, Female, medicine.symptom, business, 030217 neurology & neurosurgery, Biomarkers
Abstract

Inflammatory mediators and metalloproteinases are altered in acute ischemic stroke (AIS) and play a detrimental effect on clinical severity and hemorrhagic transformation of the ischemic brain lesion. Using data from the Italian multicenter observational MAGIC (MArker bioloGici nell’Ictus Cerebrale) Study, we evaluated the effect of inflammatory and metalloproteinases profiles on three-month functional outcome, hemorrhagic transformation and mortality in 327 patients with AIS treated with intravenous thrombolys in according to SITS-MOST (Safe Implementation of Thrombolysis in Stroke-MOnitoring STudy) criteria. Circulating biomarkers were assessed at baseline and 24 h after thrombolysis. Adjusting for age, sex, baseline glycemia and National Institute of Health Stroke Scale, history of atrial fibrillation or congestive heart failure, and of inflammatory diseases or infections, baseline alpha-2macroglobulin (A2M), baseline serum amyloid protein (SAP) and pre-post tissue-plasminogen activator (tPA) variations (Δ) of metalloproteinase 9, remained significantly and independently associated with three-month death [OR (95% CI):A2M:2.99 (1.19–7.53); SAP:5.46 (1.64–18.74); Δmetalloproteinase 9:1.60 (1.12–2.27)]. The addition of baseline A2M and Δmetalloproteinase 9 or baseline SAP and Δmetalloproteinase 9 (model-2 or model-3) to clinical variables (model-1) significantly improved the area under curve for prediction of death [model-2 with A2M: p = 0.0205; model-3 with SAP: p = 0.001]. In conclusion, among AIS patients treated with thrombolysis, circulating A2M, SAP and Δmetalloproteinase 9 are independent markers of poor outcome. These results may prompt controlled clinical research about agents antagonizing their effect.

Published
2017

43. Use of rivaroxaban in patients with stroke

Author

Stefano Ricci, Danilo Toni, Leandro Provinciali, Valeria Caso, Maurizio Melis, Antonio Carolei, Giuseppe Micieli, Domenico Consoli, Domenico Inzitari, Massimo Del Sette, Paola Santalucia, and Vito Toso

Subjects
medicine.medical_specialty, Neurology, Dermatology, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Rivaroxaban, medicine, Humans, Intensive care medicine, Stroke, Intracerebral hemorrhage, business.industry, Warfarin, Atrial fibrillation, General Medicine, medicine.disease, Clinical trial, Psychiatry and Mental health, Anesthesia, Neurology (clinical), Neurosurgery, business, Anti-coagulants, Ischemic stroke, 2708, Psychiatry and Mental Health, 030217 neurology & neurosurgery, Factor Xa Inhibitors, medicine.drug
Abstract

Rivaroxaban, an inhibitor of Factor Xa, is a direct oral anti-coagulant that has been found to be non-inferior to warfarin in preventing cerebral ischemia in patients with non-valvular atrial fibrillation and in the subgroup of patients with a history of the previous stroke or transient ischemic attack. Vascular neurologists in daily clinical practice may encounter patients taking rivaroxaban or patients who may benefit from its use. In this paper, we review the current clinical indications, contraindications, and clinical management guidelines for rivaroxaban while providing a special focus on neurological aspects and expert opinions on rivaroxaban therapy management in various situations that a neurologist may encounter when treating patients with an ischemic stroke (including those requiring intravenous or intra-arterial reperfusion therapy) and patients with an intracerebral hemorrhage. Since data from clinical trials and real-life data are missing in some clinical situations, strong recommendations are not always available. Nevertheless, practical guidelines should be adopted to maximize benefits from this oral anti-coagulant.

Published
2017

44. 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

45. 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

46. 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

47. 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

48. Relevance of Prehospital Stroke Code Activation for Acute Treatment Measures in Stroke Care: A Review

Author

Marzia, Baldereschi, Benedetta, Piccardi, Antonio, Di Carlo, Giuseppe, Lucente, Donata, Guidetti, Domenico, Consoli, Leandro, Provinciali, Danilo, Toni, Maria Luisa, Sacchetti, Bianca Maria, Polizzi, Domenico, Inzitari, and Livia, Candelise

Subjects
Emergency Medical Services, Time Factors, medicine.medical_treatment, acute management of stroke, Fibrinolytic Agents, Intervention (counseling), medicine, Humans, Thrombolytic Therapy, Relevance (information retrieval), Disease management (health), Stroke, business.industry, Clinical study design, Clinical Coding, acute stroke therapy, prehospital delay, prehospital management of stroke, stroke code, Disease Management, Thrombolysis, medicine.disease, Clinical trial, Neurology, Tissue Plasminogen Activator, Cohort, Neurology (clinical), Medical emergency, Cardiology and Cardiovascular Medicine, business
Abstract

Background: The use of emergency services with prehospital stroke assessment and early notification to the treatment hospital (stroke code) is a crucial determinant of delay time for acute stroke treatment. We reviewed and summarized the literature on prehospital stroke code system implementation. Methods: Two databases were explored (last update June 20, 2011) with 3 key words (stroke code, stroke prehospital management and stroke prehospital services). Inclusion criteria were: randomized and quasirandomized controlled trials, cohort and case-control studies, and hospital- and emergency-based registers, with no year or language restrictions. We examined the reference lists of all included articles. All potentially relevant reports and abstracts were transcribed into a specifically designed data abstraction form. Results: Only 19 of the 680 studies which were initially retrieved, published from 1999 to 2011, fulfilled our inclusion criteria. One clinical trial was identified. Large differences in stroke code procedures and study designs within and across countries prohibited the pooling of the data. Most studies were carried out in urban areas. Assuming the rate of tissue-plasminogen activator treatment as the performance measure, most studies report a significant increase in the rate of treatment (increase between 3.2 and 16%) with only 1 study not reporting any increase. Conclusions: Despite its limitations, this review suggests that the use of prehospital stroke code is an important intervention to improve the accessibility of the benefits of thrombolysis, especially when implemented together with educational campaigns to optimize the awareness and behavior of patients and bystanders.

Published
2012
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49. 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
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50. The role of emergency neurology in Italy: outcome of a consensus meeting for a intersociety position

Author

Gioacchino Tedeschi, Domenico Consoli, Domenico Inzitari, Danilo Toni, Fabrizio A. de Falco, Roberto Sterzi, and Giuseppe Micieli

Subjects
Societies, Scientific, medicine.medical_specialty, Neurology, Organisational models, Consensus, Specialty, Clinical Neurology, Dermatology, Outcome (game theory), Medicine, Humans, Neurological specialty, Psychiatry, Brain Diseases, business.industry, General Medicine, medicine.disease, Hospital care, Comprehension, Psychiatry and Mental health, Italy, Healthcare Organization, Position paper, Position (finance), Emergency neurology, Neurology (clinical), Medical emergency, Neurosurgery, Hospital setting, Emergencies, business
Abstract

A possible definition of clinical, educational and organizing aspects of emergency neurology in Italy is reported in this position paper of Emergency Neurology Intersociety Group, created in 2008 among the two neurological Societies in Italy: Societa Italiana di Neurologia and Societa di Neuroscienze Ospedaliere. The aim of this Group has been the evaluation of the role of neurologist in the emergency setting of Italian hospitals, as well as of the description of different scenarios in which a ward dedicated to a semi-intensive care of neurological emergencies could have a role in the actual organization of academic or general hospitals in our Country. The actual great relevance of neurologist activity in the inpatients treatment, in fact, is actually misleaded as it is the considerable significance of neurological expertise, techniques and support in hospital care pathways also involving neurological manifestations throughout the course of other diseases. Finally, the possible contents of educational programs orienting neurological specialty towards a better comprehension and management of emergency neurological problems either in terms of specific formation or of techniques to be learned by emergency neurologist, are reported as a results of the Consensus Workshop hold in Castiglioncello (LI) in September 12th, 2009.

Published
2011

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