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1. Advances in Embolization of bAVMs

Author

Renieri, L., Limbucci, N., Mangiafico, S., Steiger, H.-J., Series editor, Tsukahara, Tetsuya, editor, Pasqualin, Alberto, editor, Esposito, Giuseppe, editor, Regli, Luca, editor, and Pinna, Giampietro, editor

Published
2016
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2. Mechanical thrombectomy in patients with heart failure: the Italian registry of Endovascular Treatment in Acute Stroke

Author

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

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

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

Author

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

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

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

Published
2022

4. FRED Italian Registry: a multicenter experience with the flow re-direction endoluminal device for intracranial aneurysms

Author

Piano, Mariangela, Valvassori, Luca, Lozupone, Emilio, Pero, Guglielmo, Quilici, Luca, Boccardi Edoardo, Bergui M, Stura G, Guidetti G, Peschillo S, Isalberti M, Paolucci A, Bracco S, Cioni S, De Nicola M, Giannoni M, Comelli S, Comelli C, Castellan L, Allegretti L, Menozzi R, Saltarelli A, Caputo N, Resta M, Donatelli M, Pedicelli A, Causin F, Cester G, Cagliari E, Cavasin N, Cagliari G, Petralia B, Gallesio I, Briganti F, Tortora F, Natrella M, Papa R, Pitrone A, Di Paola F, Thyrion F, Lafe E, Ciceri E, Faragò G, Remida P, Padolecchia R, DiVenuto I, Scomazzoni F, Simionato F, Mangiafico S, Limbucci N, Lazzarotti G., Piano, Mariangela, Valvassori, Luca, Lozupone, Emilio, Pero, Guglielmo, Quilici, Luca, Boccardi, Edoardo, Bergui, M, Stura, G, Guidetti, G, Peschillo, S, Isalberti, M, Paolucci, A, Bracco, S, Cioni, S, De Nicola, M, Giannoni, M, Comelli, S, Comelli, C, Castellan, L, Allegretti, L, Menozzi, R, Saltarelli, A, Caputo, N, Resta, M, Donatelli, M, Pedicelli, A, Causin, F, Cester, G, Cagliari, E, Cavasin, N, Cagliari, G, Petralia, B, Gallesio, I, Briganti, F, Tortora, F, Natrella, M, Papa, R, Pitrone, A, Di Paola, F, Thyrion, F, Lafe, E, Ciceri, E, Faragò, G, Remida, P, Padolecchia, R, Divenuto, I, Scomazzoni, F, Simionato, F, Mangiafico, S, Limbucci, N, and Lazzarotti, G.

Subjects
MCA = middle cerebral artery, medicine.medical_specialty, ICA = internal carotid artery, AE = adverse event, endovascular procedures, FRED, FDD = flow diverter device, vascular disorders, Asymptomatic, 03 medical and health sciences, 0302 clinical medicine, Aneurysm, DSA = digital subtraction angiography, Modified Rankin Scale, Complete occlusion, medicine, FRED = flow re-direction endoluminal device, Adverse effect, AsE = asymptomatic event, SAE = serious AE, BA = basilar artery, TIA = transient ischemic attack, GDC = Guglielmi detachable coil, VA = vertebral artery, medicine.diagnostic_test, PCoA = posterior communicating artery, business.industry, endovascular procedure, Mortality rate, AChA = anterior choroidal artery, General Medicine, ICH = intracerebral hemorrhage, OKM = O’Kelly-Marotta, PICA = posterior inferior cerebellar artery, RROC = Raymond-Roy occlusion classification, SAH = subarachnoid hemorrhage, interventional neurosurgery, intracranial aneurysm, mRS = modified Rankin Scale, new device, medicine.disease, Surgery, 030220 oncology & carcinogenesis, Sac shrinkage, Angiography, medicine.symptom, business, 030217 neurology & neurosurgery
Abstract

OBJECTIVEThe introduction of flow-diverter devices (FDDs) has revolutionized the endovascular treatment of intracranial aneurysms. Here the authors present their Italian multicenter experience using the flow re-direction endoluminal device (FRED) in the treatment of cerebral aneurysms, evaluating both short- and long-term safety and efficacy of this device.METHODSBetween February 2013 and December 2014, 169 consecutive aneurysms treated using FRED in 166 patients were entered into this study across 30 Italian centers. Data collected included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and posttreatment modified Rankin Scale scores, as well as angiographic and cross-sectional CT/MRI follow-up at 3–6 months and/or 12–24 months per institutional standard of care. All images were reviewed and adjudicated by an independent core lab.RESULTSOf the 169 lesions initially entered into the study, 4 were later determined to be extracranial or nonaneurysmal by the core lab and were excluded, leaving 165 aneurysms in 162 patients treated in 163 procedures. Ninety-one (56.2%) patients were asymptomatic with aneurysms found incidentally. Of the 165 aneurysms, 150 (90.9%) were unruptured. One hundred thirty-four (81.2%) were saccular, 27 (16.4%) were fusiform/dissecting, and the remaining 4 (2.4%) were blister-like. One hundred thirty-seven (83.0%) arose from the anterior circulation.FRED deployment was impossible in 2/163 (1.2%) cases, and in an additional 4 cases (2.5%) the device was misdeployed. Overall mortality and morbidity rates were 4.3% and 7.3%, respectively, with rates of mortality and morbidity potentially related to FRED of up to 2.4% and 6.2%, respectively. Neuroimaging follow-up at 3–6 months showed complete or nearly complete occlusion of the aneurysm in 94% of cases, increasing to 96% at 12–24 months’ follow-up. Aneurysmal sac shrinkage was observed in 78% of assessable aneurysms.CONCLUSIONSThis preliminary experience using FRED for endovascular treatment of complex unruptured and ruptured aneurysms showed a high safety and efficacy profile that is comparable to those of other FDDs currently in use.

Published
2020

5. EP52* Initial experience with the trevo NXT stent retriever

Author

Etter, MM, primary, Möhlenbruch, M, additional, Weyland, CS, additional, Pérez-García, C, additional, Moreu, M, additional, Capasso, F, additional, Limbucci, N, additional, Nikoubashman, O, additional, Wiesmann, M, additional, Blackham, K, additional, Tsogkas, I, additional, Sporns, P, additional, Ospel, J, additional, Brehm, A, additional, and Psychogios, M-N, additional

Published
2021
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6. Posterior Circulation Endovascular Thrombectomy for Large-Vessel Occlusion: Predictors of Favorable Clinical Outcome and Analysis of First-Pass Effect

Author

Alexandre, A.M., primary, Valente, I., additional, Consoli, A., additional, Piano, M., additional, Renieri, L., additional, Gabrieli, J.D., additional, Russo, R., additional, Caragliano, A.A., additional, Ruggiero, M., additional, Saletti, A., additional, Lazzarotti, G.A., additional, Pileggi, M., additional, Limbucci, N., additional, Cosottini, M., additional, Cervo, A., additional, Viaro, F., additional, Vinci, S.L., additional, Commodaro, C., additional, Pilato, F., additional, and Pedicelli, A., additional

Published
2021
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8. Incidence, Characteristics and Outcomes of Large Vessel Stroke in COVID-19 Cohort: A Multicentric International Study

Author

Nayak S, Schüller M, Renieri L, Emad Nourollahzadeh, Galván J, Hai Sun, Amit Singla, Ambooj Tiwari, Xavier A, Adam A Dmytriw, Martínez-Galdámez M, Anil Nanda, Gaurav Gupta, Roychoudhury S, Chirag D. Gandhi, Mufti Fa, Hashim Z, Lonzano Jd, Luca Quilici, Limbucci N, Arenillas-Lara Jf, Pankaj K Agarwalla, Tannavi Prakash, Dileep R. Yavagal, Priyank Khandelwal, Mariangela Piano, Desousa K, and Guglielmo Pero

Subjects
Pediatrics, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), business.industry, viruses, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Incidence (epidemiology), fungi, virus diseases, Large vessel, macromolecular substances, medicine.disease, Cohort, Pandemic, medicine, skin and connective tissue diseases, business, Stroke
Abstract

Importance: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global pandemic that has been an i

Published
2020
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9. E-230 Comparison of PED and FRED flow diverters for posterior circulation aneurysms: a propensity-score matched cohort study

Author

Griessenauer, C, primary, Enriquez-Marulanda, A, additional, Xiang, S, additional, Hong, T, additional, Zhang, H, additional, Taussky, P, additional, Grandhi, R, additional, Waqas, M, additional, Tutino, V, additional, Siddiqui, A, additional, Levy, E, additional, Ogilvy, C, additional, Thomas, A, additional, Ulfert, C, additional, Möhlenbruch, M, additional, Renieri, L, additional, Limbucci, N, additional, Parra-Fariñas, C, additional, Burkhardt, J, additional, Kan, P, additional, Rinaldo, L, additional, Lanzino, G, additional, Brinjikji, W, additional, Müller-Thies-Broussalis, E, additional, Killer-Oberpfalzer, M, additional, Islak, C, additional, Kocer, N, additional, Sonnberger, M, additional, Engelhorn, T, additional, Ghuman, M, additional, Yang, V, additional, Salehani, A, additional, Harrigan, M, additional, Radovanovic, I, additional, and Dmytriw, A, additional

Published
2020
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10. O-017 Repeat flow diversion for previously failed flow diversion: multicenter experience

Author

Salem, M, primary, Sweid, A, additional, Kuhn, A, additional, Dmytriw, A, additional, Gomez-Paz, S, additional, Maragkos, G, additional, Waqas, M, additional, Parra-Farinas, C, additional, Salehani, A, additional, Adeeb, N, additional, Brouwer, P, additional, Pickett, G, additional, Ghuman, M, additional, Yang, V, additional, Weill, A, additional, Cognard, C, additional, Renieri, L, additional, Kan, P, additional, Limbucci, N, additional, Mendes Pereira, V, additional, Harrigan, M, additional, Puri, A, additional, Levy, E, additional, Moore, J, additional, Ogilvy, C, additional, Marotta, T, additional, Jabbour, P, additional, and Thomas, A, additional

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

Author

Cappellari, M., Mangiafico, S., Saia, V., Pracucci, G., Nappini, S., Nencini, P., Konda, D., Sallustio, F., Vallone, S., Zini, A., Bracco, S., Tassi, R., Bergui, M., Cerrato, P., Pitrone, A., Grillo, F., Saletti, A., De Vito, A., Gasparotti, Roberto, Magoni, M., Puglielli, E., Casalena, A., Causin, F., Baracchini, C., Castellan, L., Malfatto, L., Menozzi, R., Scoditti, U., Comelli, C., Duc, E., Comai, A., Franchini, E., Cosottini, M., Mancuso, M., Peschillo, S., De Michele, M., Giorgianni, A., Delodovici, M. L., Lafe, E., Denaro, M. F., Burdi, N., Interno, S., Cavasin, N., Critelli, A., Chiumarulo, L., Petruzzellis, M., Doddi, M., Carolei, A., Auteri, W., Petrone, A., Padolecchia, R., Tassinari, T., Pavia, M., Invernizzi, P., Turcato, G., Forlivesi, S., Ciceri, E. F. M., Bonetti, B., Inzitari, D., Toni D., Limbucci N, Consoli, A, Renieri, L, Fainardi, E, Gandini, R, Pampana, E, Diomedi, M, Koch, G, Verganti, L, Sacchetti, F, Zelent, G, Bigliardi, G, Picchetto, L, Vandelli, L, Romano, Dg, Cioni, S, Gennari, P, Cerase, A, Martini, G, Stura, G, Daniele, D, Naldi, A, Papa, R, Vinci, Sl, Bernava, G, Velo, M, Caragliano, A, Tessitore, A, Buonomo, O, Musolino, R, La Spina, P, Casella, C, Carolina Fazio, M, Cotroneo, M, Onofrio, M, Azzini, C, Casetta, I, Mardighian, D, Frigerio, M, Costa, A, Di Egidio, V, Lattanzi, R, Assetta, M, Cester, G, Mavilio, N, Serrati, C, Piazza, P, Epifani, E, Andreone, A, Castellini, P, Latte, L, Grisendi, I, Vaudano, G, Comelli, S, Cavallo, R, Chianale, G, Simonetti, L, Taglialatela, F, Isceri, S, Procaccianti, G, Zaniboni, A, Borghi, A, Bonatti, G, Ferro, F, Bonatti, M, Dall'Ora, E, Currò Dossi, R, Turri, E, Turri, M, Puglioli, M, Lazzarotti, G, Lauretti, D, Giannini, N, Maccarone, M, Orlandi, G, Chiti, A, Guidetti, G, Biraschi, F, Falcou, A, Anzini, A, Mancini, A, Fausti, S, Di Mascio, Mt, Durastanti, L, Sbardella, E, Mellina, V, Baruzzi, F, Pellegrino, C, Terrana, A, Carimati, F, Ruggiero, M, Sanna, A, Passarin, Mg, Colosimo, C, Pedicelli, A, D'Argento, F, Alexandre, A, Frisullo, G, Zappoli, F, Martignoni, A, Cavallini, A, Persico, A, Valvassori, L, Piano, M, Agostoni, E, Motto, C, Gatti, A, Longoni, M, Guccione, A, Tortorella, R, Zampieri, P, Zimatore, D, Grazioli, A, Ricciardi, Gk, Augelli, R, Bovi, P, Tomelleri, G, Micheletti, N, Semeraro, V, Lucarelli, N, Ganimede, M, Tinelli, A, Pia Prontera, M, Pesare, A, Cagliari, E, Quatrale, R, Federico, F, Passalacqua, G, Filauri, P, Orlandi, B, De Santis, F, Gabriele, A, Tiseo, C, Armentano, A, Di Benedetto, O, Silvagni, U, Perrotta, P, Crispino, E, Stancati, F, Rizzuto, S, Pugliese, P, Pisani, E, Siniscalchi, A, Gaudiano, C, Pirritano, D, Del Giudice, F, Calia, S, Ganci, G, Sugo, A, Scomazzoni, F, Simionato, F, Roveri, L, De Nicola, M, Giannoni, M, Bruni, S, Gambelli, E, Provinciali, L, Carriero, A, Coppo, L, Baldan, J, Paolo Nuzzi, N, Marcheselli, S, Corato, M, Cotroneo, E, Ricciardi, F, Gigli, R, Pozzessere, C, Pezzella, Fr, Corsi, F, Squassina, G, Cobelli, M, Morassi, M, Magni, Eugenio, Pepe, F, Bigni, B, Costa, P, Crabbio, M, Griffini, S, Palmerini, F, Piras, Mp, Natrella, M, Fanelli, G, Cristoferi, M, Bottacchi, E, Corso, G, Tosi, P, Amistà, P, Russo, M, Tettoni, S, Gallesio, I, Mascolo, Mc, Meloni, Gb, Fabio, C, Maiore, M, Pintus, F, Pischedda, A, Manca, A, Mongili, C, Zanda, B, Baule, A, Pappalardo, Mp, Craparo, G, Gallo, C, Monaco, S, Mannino, M, Terruso, V, Muto, M, Guarnieri, G, Andreone, V, Dui, G, Ticca, A, Salmaggi, A, Iannucci, G, Pinna, V, Di Clemente, L, Perini, F, De Boni, A, De Luca, C, De Giorgi, F, Corraine, S, Enne, P, Ganau, C, Piras, V., Gasparotti R., Magni E (ORCID:0000-0002-2235-2280), Cappellari, M., Mangiafico, S., Saia, V., Pracucci, G., Nappini, S., Nencini, P., Konda, D., Sallustio, F., Vallone, S., Zini, A., Bracco, S., Tassi, R., Bergui, M., Cerrato, P., Pitrone, A., Grillo, F., Saletti, A., De Vito, A., Gasparotti, Roberto, Magoni, M., Puglielli, E., Casalena, A., Causin, F., Baracchini, C., Castellan, L., Malfatto, L., Menozzi, R., Scoditti, U., Comelli, C., Duc, E., Comai, A., Franchini, E., Cosottini, M., Mancuso, M., Peschillo, S., De Michele, M., Giorgianni, A., Delodovici, M. L., Lafe, E., Denaro, M. F., Burdi, N., Interno, S., Cavasin, N., Critelli, A., Chiumarulo, L., Petruzzellis, M., Doddi, M., Carolei, A., Auteri, W., Petrone, A., Padolecchia, R., Tassinari, T., Pavia, M., Invernizzi, P., Turcato, G., Forlivesi, S., Ciceri, E. F. M., Bonetti, B., Inzitari, D., Toni D., Limbucci N, Consoli, A, Renieri, L, Fainardi, E, Gandini, R, Pampana, E, Diomedi, M, Koch, G, Verganti, L, Sacchetti, F, Zelent, G, Bigliardi, G, Picchetto, L, Vandelli, L, Romano, Dg, Cioni, S, Gennari, P, Cerase, A, Martini, G, Stura, G, Daniele, D, Naldi, A, Papa, R, Vinci, Sl, Bernava, G, Velo, M, Caragliano, A, Tessitore, A, Buonomo, O, Musolino, R, La Spina, P, Casella, C, Carolina Fazio, M, Cotroneo, M, Onofrio, M, Azzini, C, Casetta, I, Mardighian, D, Frigerio, M, Costa, A, Di Egidio, V, Lattanzi, R, Assetta, M, Cester, G, Mavilio, N, Serrati, C, Piazza, P, Epifani, E, Andreone, A, Castellini, P, Latte, L, Grisendi, I, Vaudano, G, Comelli, S, Cavallo, R, Chianale, G, Simonetti, L, Taglialatela, F, Isceri, S, Procaccianti, G, Zaniboni, A, Borghi, A, Bonatti, G, Ferro, F, Bonatti, M, Dall'Ora, E, Currò Dossi, R, Turri, E, Turri, M, Puglioli, M, Lazzarotti, G, Lauretti, D, Giannini, N, Maccarone, M, Orlandi, G, Chiti, A, Guidetti, G, Biraschi, F, Falcou, A, Anzini, A, Mancini, A, Fausti, S, Di Mascio, Mt, Durastanti, L, Sbardella, E, Mellina, V, Baruzzi, F, Pellegrino, C, Terrana, A, Carimati, F, Ruggiero, M, Sanna, A, Passarin, Mg, Colosimo, C, Pedicelli, A, D'Argento, F, Alexandre, A, Frisullo, G, Zappoli, F, Martignoni, A, Cavallini, A, Persico, A, Valvassori, L, Piano, M, Agostoni, E, Motto, C, Gatti, A, Longoni, M, Guccione, A, Tortorella, R, Zampieri, P, Zimatore, D, Grazioli, A, Ricciardi, Gk, Augelli, R, Bovi, P, Tomelleri, G, Micheletti, N, Semeraro, V, Lucarelli, N, Ganimede, M, Tinelli, A, Pia Prontera, M, Pesare, A, Cagliari, E, Quatrale, R, Federico, F, Passalacqua, G, Filauri, P, Orlandi, B, De Santis, F, Gabriele, A, Tiseo, C, Armentano, A, Di Benedetto, O, Silvagni, U, Perrotta, P, Crispino, E, Stancati, F, Rizzuto, S, Pugliese, P, Pisani, E, Siniscalchi, A, Gaudiano, C, Pirritano, D, Del Giudice, F, Calia, S, Ganci, G, Sugo, A, Scomazzoni, F, Simionato, F, Roveri, L, De Nicola, M, Giannoni, M, Bruni, S, Gambelli, E, Provinciali, L, Carriero, A, Coppo, L, Baldan, J, Paolo Nuzzi, N, Marcheselli, S, Corato, M, Cotroneo, E, Ricciardi, F, Gigli, R, Pozzessere, C, Pezzella, Fr, Corsi, F, Squassina, G, Cobelli, M, Morassi, M, Magni, Eugenio, Pepe, F, Bigni, B, Costa, P, Crabbio, M, Griffini, S, Palmerini, F, Piras, Mp, Natrella, M, Fanelli, G, Cristoferi, M, Bottacchi, E, Corso, G, Tosi, P, Amistà, P, Russo, M, Tettoni, S, Gallesio, I, Mascolo, Mc, Meloni, Gb, Fabio, C, Maiore, M, Pintus, F, Pischedda, A, Manca, A, Mongili, C, Zanda, B, Baule, A, Pappalardo, Mp, Craparo, G, Gallo, C, Monaco, S, Mannino, M, Terruso, V, Muto, M, Guarnieri, G, Andreone, V, Dui, G, Ticca, A, Salmaggi, A, Iannucci, G, Pinna, V, Di Clemente, L, Perini, F, De Boni, A, De Luca, C, De Giorgi, F, Corraine, S, Enne, P, Ganau, C, Piras, V., Gasparotti R., and Magni E (ORCID:0000-0002-2235-2280)

Abstract

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

Published
2019

16. Risk of Branch Occlusion and Ischemic Complications with the Pipeline Embolization Device in the Treatment of Posterior Circulation Aneurysms

Author

Adeeb, N., primary, Griessenauer, C.J., additional, Dmytriw, A.A., additional, Shallwani, H., additional, Gupta, R., additional, Foreman, P.M., additional, Shakir, H., additional, Moore, J., additional, Limbucci, N., additional, Mangiafico, S., additional, Kumar, A., additional, Michelozzi, C., additional, Zhang, Y., additional, Pereira, V.M., additional, Matouk, C.C., additional, Harrigan, M.R., additional, Siddiqui, A.H., additional, Levy, E.I., additional, Renieri, L., additional, Marotta, T.R., additional, Cognard, C., additional, Ogilvy, C.S., additional, and Thomas, A.J., additional

Published
2018
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24. Diagnostica Radiologica

Author

Masciocchi, Carlo, Gallucci, M, Marsili, L, DI CESARE, Ernesto, Zugaro, L, Giordano, Av, Limbucci, N, Catalucci, A, Carducci, S, and Gismondi, C.

Published
2005

28. Pediatric Inflammatory Diseases

Author

Catalucci, A., primary, Anselmi, M., additional, Splendiani, A., additional, Smith, J.D., additional, Limbucci, N., additional, Giangaspero, F., additional, and Gallucci, M., additional

Published
2012
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29. Pediatric Inflammatory Diseases

Author

Splendiani, A., primary, Catalucci, A., additional, Limbucci, N., additional, Turner, M., additional, Krings, T., additional, and Gallucci, M., additional

Published
2012
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30. Pediatric Inflammatory Diseases

Author

Gallucci, M., primary, Smith, J.D., additional, Limbucci, N., additional, Rossi, A., additional, Demaerel, P., additional, Krings, T., additional, Damico, A., additional, and Micheli, C., additional

Published
2012
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41. O-018 Flow diversion for the treatment of basilar apex aneurysms

Author

Dmytriw, Adeeb, N, Kumar, A, Griessenauer, C, Ogilvy, C, Foreman, P, Shallwani, H, Limbucci, N, Mangiafico, S, Michelozzi, C, Krings, T, Pereira, V Mendes, Matouk, C, Zhang, Y, Harrigan, M, Phan, K, Shakir, H, Siqqiqui, A, Levy, E, Renieri, L, Cognard, C, Thomas, A, and Marotta, T

Abstract

IntroductionFlow diversion for posterior circulation aneurysms using flow diversion constitutes an increasingly common off-label use. Basilar apex aneurysms are daunting lesions that present a significant treatment challenge. This is the largest series of basilar apex aneurysms treated with flow diversion to-date.MethodsA retrospective review of prospectively maintained databases at eight academic institutions was performed from the years 2009 to 2016 to identify patients with basilar apex aneurysms treated with PED placement. Clinical and radiographic data were analyzed with emphasis on occlusion and complication rates.Results16 consecutive patients (median age 62 years, male:female ratio of 1:2.2) underwent 18 procedures to treat 131 posterior circulation aneurysms with either Pipeline Embolization Device or Flow Redirection Endoluminal Device. All but one patient (94%) had a neurologic deficit attributable to the aneurysm prior to their procedure. Four attempts (25%) at flow-diversion were performed for aneurysmal subarachnoid hemorrhage, with 3 for saccular and 1 for blister morphology.At a median follow-up of 9 months, complete (100%) and near-complete (90%–99%) occlusion was noted in 69% of aneurysms. The rate of partial (<90%) occlusion was higher in patients treated with flow-diversion alone (3/7; 43%) and flow-diversion with coiling (2/9; 22%). However, there was no apparent difference in mRS at follow-up. Retreatment with an additional flow-diverter occurred in patients with larger aneurysm necks (8 and 15 mm) and adjunctive coiling, but had no other attributes in common. Major complications (≥2 points in mRS change) occurred in one patient (6%), who experienced PCA and cerebellar strokes as well as SAH after placement of a single flow diverter. Minor complications (<2 points in mRS change) occurred in 3 additional patients (19%). Symptomatic thromboembolic and hemorrhagic complications occurred in 2/18 of procedures, each (13%); all in the postprocedural setting. In addition, 1/18 procedure resulted in development of perianeurysmal edema and mass effect (6%). Aneurysms with intraluminal thrombus had higher complication rates, though they were not necessarily larger.ConclusionFlow diversion for the treatment of basilar apex aneurysms results in acceptable occlusion rates, and compares favorably with the natural history of the disease. Both primary flow diversion and rescue after clipping/coiling resulted in mRS that was either equal or better than at presentation, and the technology represents a viable alternative to primary coiling or clipping in patients who are poor candidates for these.DisclosuresA. Dmytriw:None. N. Adeeb:None. A. Kumar:None. C. Griessenauer:None. C. Ogilvy:None. P. Foreman:None. H. Shallwani:None. N. Limbucci:None. S. Mangiafico:None. C. Michelozzi:None. T. Krings:None. V. Mendes Pereira:None. C. Matouk:None. Y. Zhang:None. M. Harrigan:None. K. Phan:None. H. Shakir:None. A. Siqqiqui:None. E. Levy:None. L. Renieri:None. C. Cognard:None. A. Thomas:2; C; Research Steering Committee, Stryker. T. Marotta:None.

Published
2017
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42. Long-term follow-up of the DERIVO® Embolization Device (DED®) for intracranial aneurysms: The Italian Multicentric Registry

Author

Giuseppe Faragò, C Princiotta, Paolo Cerini, Giuseppe Lucente, Simone Peschillo, Maurizio De Nicola, Luca Quilici, Lucio Castellan, Luigi Chiumarulo, Nicola Limbucci, Nevia Caputo, Maria Ruggiero, Nicola Burdi, Luigi Gozzoli, Mariangela Piano, Nicola Cavasin, Chiara Comelli, Elvis Lafe, Francesco Briganti, Florio F, Nunzio Paolo Nuzzi, Francesco Asteggiano, Marco Pavia, Guglielmo Pero, Emilio Lozupone, Annalisa Sgoifo, Edoardo Boccardi, Dikran Mardighian, Andrea Giorgianni, Giuseppe Iannucci, Guido Trasimeni, Elisa Ciceri, Luca Valvassori, Aldo Paolucci, Alessandro Pedicelli, Guido A Lazzarotti, Simone Vagnarelli, Massimiliano Natrella, Giuseppe Ganci, Paolo Remida, Ivan Gallesio, Piano, M., Lozupone, E., Sgoifo, A., Nuzzi, N. P., Asteggiano, F., Pero, G., Quilici, L., Iannucci, G., Cerini, P., Comelli, C., Peschillo, S., Princiotta, C., Pedicelli, A., Limbucci, N., Ganci, G., Trasimeni, G., Ciceri, E., Farago, G., Giorgianni, A., Denicola, M., Remida, P., Lafe, E., Mardighian, D., Ruggiero, M., Lazzarotti, G. A., Cavasin, N., Castellan, L., Chiumarulo, L., Burdi, N., Paolucci, A., Briganti, F., Natrella, M., Florio, F. P., Pavia, M., Gallesio, I., Lucente, G., Gozzoli, L., Caputo, N., Vagnarelli, S., Boccardi, E., and Valvassori, L.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Neurosurgery, 03 medical and health sciences, Embolization, 0302 clinical medicine, Aneurysm, Modified Rankin Scale, Occlusion, medicine, Humans, Registries, Adverse effect, Retrospective Studies, medicine.diagnostic_test, business.industry, Mortality rate, Endovascular Procedures, medicine.disease, Intracranial aneurysm, Embolization, Therapeutic, Cerebral Angiography, Surgery, Treatment Outcome, Italy, 030220 oncology & carcinogenesis, Angiography, Stents, Neurology (clinical), Therapeutic, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

Background The flow-diverter devices (FDDs) safety and effectiveness have been demonstrated by large series and meta-analyses. Due to the high occlusion rates and the acceptable morbidity rates of FDDs, the indications for their use are continuously expanding. We presented our Italian multicentric experience using the second generation of DERIVO® Embolization Device (DED®; Acandis, Pforzheim, Germany) to cure cerebral aneurysms, evaluating both middle and long-term safety and efficacy of this device. Methods Between July 2016 and September 2017 we collected 109 consecutive aneurysms in 108 patients treated using DED® during 109 endovascular procedures in 34 Italian centers (100/109 aneurysms were unruptured, 9/109 were ruptured). The collected data included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and post-treatment modified Rankin Scale scores. Midterm and long-term clinical, angiographic and cross-sectional CT/MR follow-up were recorded and collected until December 2018. Results In 2/109 cases, DED® placement was classified as technical failures. The overall mortality and morbidity rates were respectively 6.5% and 5.5%. Overall DERIVO® related mortality and morbidity rates were respectively 0% and 4.6% (5 out of 108 patients). Midterm neuroimaging follow-up showed the complete or nearly complete occlusion of the aneurysm in 90% cases, which became 93% at long-term follow-up. Aneurysmal sac shrinking was observed in 65% of assessable aneurysms. Conclusions Our multicentric experience using DED® for endovascular treatment of unruptured and ruptured aneurysms showed a high safety and efficacy profile, substantially equivalent or better compared to the other FDDs.

Published
2021

43. European Multicenter Study of ET-COVID-19

Author

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

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

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

Published
2020
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44. Development of machine learning models to prognosticate chronic shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage

Author

Sergio Nappini, Eleonora Becattini, Tommaso Matteuzzi, Giovanni Muscas, Salvatore Mangiafico, Francesca Battista, Simone Orlandini, B. Carangelo, Leonardo Renieri, Alessandro Della Puppa, Antonio Laiso, Nicola Limbucci, Muscas G., Matteuzzi T., Becattini E., Orlandini S., Battista F., Laiso A., Nappini S., Limbucci N., Renieri L., Carangelo B.R., Mangiafico S., and Della Puppa A.

Subjects
Adult, Male, medicine.medical_specialty, Subarachnoid hemorrhage, Prognostic models, Machine learning, computer.software_genre, 03 medical and health sciences, 0302 clinical medicine, Original Article - Vascular Neurosurgery - Other, Risk Factors, Shunt-dependency, medicine, Humans, 030212 general & internal medicine, Neuroradiology, Aged, Retrospective Studies, Hydrocephalu, business.industry, Middle Aged, medicine.disease, Matthews correlation coefficient, Prognosis, Cerebrospinal Fluid Shunts, Hydrocephalus, Random forest, Surgery, Female, Neurology (clinical), Artificial intelligence, Neurosurgery, business, Prognostic model, computer, 030217 neurology & neurosurgery, Shunt (electrical)
Abstract

Background Shunt-dependent hydrocephalus significantly complicates subarachnoid hemorrhage (SAH), and reliable prognosis methods have been sought in recent years to reduce morbidity and costs associated with delayed treatment or neglected onset. Machine learning (ML) defines modern data analysis techniques allowing accurate subject-based risk stratifications. We aimed at developing and testing different ML models to predict shunt-dependent hydrocephalus after aneurysmal SAH. Methods We consulted electronic records of patients with aneurysmal SAH treated at our institution between January 2013 and March 2019. We selected variables for the models according to the results of the previous works on this topic. We trained and tested four ML algorithms on three datasets: one containing binary variables, one considering variables associated with shunt-dependency after an explorative analysis, and one including all variables. For each model, we calculated AUROC, specificity, sensitivity, accuracy, PPV, and also, on the validation set, the NPV and the Matthews correlation coefficient (ϕ). Results Three hundred eighty-six patients were included. Fifty patients (12.9%) developed shunt-dependency after a mean follow-up of 19.7 (± 12.6) months. Complete information was retrieved for 32 variables, used to train the models. The best models were selected based on the performances on the validation set and were achieved with a distributed random forest model considering 21 variables, with a ϕ = 0.59, AUC = 0.88; sensitivity and specificity of 0.73 (C.I.: 0.39–0.94) and 0.92 (C.I.: 0.84–0.97), respectively; PPV = 0.59 (0.38–0.77); and NPV = 0.96 (0.90–0.98). Accuracy was 0.90 (0.82–0.95). Conclusions Machine learning prognostic models allow accurate predictions with a large number of variables and a more subject-oriented prognosis. We identified a single best distributed random forest model, with an excellent prognostic capacity (ϕ = 0.58), which could be especially helpful in identifying low-risk patients for shunt-dependency.

Published
2020

45. Reversible focal splenial lesions

Author

Nicola Limbucci, Ferdinando Caranci, Massimo Gallucci, Amalia Paonessa, M., Gallucci, N., Limbucci, A., Paonessa, Caranci, Ferdinando, Gallucci, M, Limbucci, N, and Paonessa, A

Subjects
Toxic diseases. Metabolic diseases, Pathology, medicine.medical_specialty, Neurology, Splenium, Corpus callosum, Corpus Callosum, Edema, medicine, Humans, Radiology, Nuclear Medicine and imaging, Pathological, CNS, Corpus callosum, Toxic diseases. Metabolic diseases, Neuroradiology, Brain Diseases, Hypoglycemic encephalopathy, business.industry, Viral encephalitis, medicine.disease, Radiography, stomatognathic diseases, Neurology (clinical), CNS, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Reversible focal lesions in the splenium of the corpus callosum (SCC) have recently been reported. They are circumscribed and located in the median aspect of the SCC. On MRI, they are hyperintense on T2-W and iso-hypointense on T1-W sequences, with no contrast enhancement. On DWI, SCC lesions are hyperintense with low ADC values, reflecting restricted diffusion due to cytotoxic edema. The common element is the disappearance of imaging abnormalities with time, including normalization of DWI. Clinical improvement is often reported. The most established and frequent causes of reversible focal lesions of the SCC are viral encephalitis, antiepileptic drug toxicity/withdrawal and hypoglycemic encephalopathy. Many other causes have been reported, including traumatic axonal injury. The similar clinical and imaging features suggest a common mechanism induced by different pathological events leading to the same results. Edema and diffusion restriction in focal reversible lesions of the SCC have been attributed to excitotoxic mechanisms that can result from different mechanisms; no unifying relationship has been found to explain all the pathologies associated with SCC lesions. In our opinion, the similar imaging, clinical and prognostic aspects of these lesions depend on a high vulnerability of the SCC to excitotoxic edema and are less dependent on the underlying pathology. In this review, the relevant literature concerning reversible focal lesions in the SCC is analyzed and hypotheses about their pathogenesis are proposed.

Published
2007

46. Stroke thrombectomy in the elderly: A propensity score matched study on a nationwide real-world registry.

Author

Romoli M, Migliaccio L, Saia V, Pracucci G, Cirillo L, Forlivesi S, Romano D, Casetta I, Fainardi E, Sallustio F, Limbucci N, Nencini P, Da Ros V, Diomedi M, Vallone S, Bigliardi G, Vinci SL, La Spina P, Bergui M, Cerrato P, Bracco S, Tassi R, Saletti A, Azzini C, Ruggiero M, Castellan L, Benzi Markushi T, Menozzi R, Pezzini A, Lazzarotti GA, Giannini N, Castellano D, Naldi A, Comai A, Dall'Ora E, Plebani M, Cappellari M, Frauenfelder G, Puglielli E, Casalena A, Burdi N, Boero G, Nappini S, Loizzo ND, Cavasin N, Critelli A, Ivaldi D, Tassinari T, Biraschi F, Nicolini E, Zimatore S, Petruzzellis M, Filauri P, Orlandi B, Gallesio I, Ferrandi D, Pavia M, Invernizzi P, Amistá P, Russo M, Paladini A, Rizzo A, Besana M, Giossi A, Filizzolo M, Mannino M, Mangiafico S, Toni D, and Zini A

Abstract

Introduction: Data on safety and efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke in older patients are limited and controversial, and people aged 80 or older were under-represented in randomized trials. Our aim was to assess EVT effect for ischemic stroke patients aged ⩾80 at a nationwide level., Patients and Methods: The cohort included stroke patients undergoing EVT from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). Patients were a priori divided into younger and older groups (<80 vs ⩾80). Primary outcome was good functional outcome (modified Rankin scale, mRS, 0-2 at 90 days). Secondary outcomes were symptomatic intracranial hemorrhage (sICH), successful reperfusion, EVT abortion. Propensity score matching (PSM) was performed between age groups for baseline features, functional status, stroke severity and neuroradiological features. Logistic regression was implemented to test the weight of age group on the predefined outcomes., Results: Overall, 5872 individuals (1:1 matching, n  = 2936 aged ⩾80 vs n  = 2936 < 80) were matched from 13,922 records. In ⩾80 group 34.1% had good functional outcome, vs 51.2% in <80 group (absolute difference = -17.1%, p  < 0.001), with a 4.4% excess in EVT abortion. Age ⩾80 was a negative independent predictor of good functional outcome (aOR = 0.4, 95% CI = 0.3-0.5), but had no impact on sICH., Discussion and Conclusion: Age ⩾80 years represents a consistent predictor of worse functional outcome, independently from successful reperfusion and sICH. Cost-effectiveness studies are needed for tailored and implement sustainable care, and research should focus on strategies to improve functional outcome in older age patient groups., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: MR declares support for educational activities from CLS-Behring and PRESTIGE-AF trial. SN declares consulting fees from Medtronic, Cerenovus, Stryker, and Balt. MC declares consultancy or advisory board fees or speaker’s honoraria from Pfizer/Bristol Meyer Squibb and Daiichi Sankyo. AZ received speaker and consultation fees from Alexion, CLS-Behring, Boehringer-Ingelheim. All the other authors report no disclosures.

Published
2024
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47. Effects of Emergent Carotid Stenting Performed before or after Mechanical Thrombectomy in the Endovascular Management of Patients with Tandem Lesions: A Multicenter Retrospective Matched Analysis.

Author

Scarcia L, Colò F, Alexandre AM, Brunetti V, Pedicelli A, Arba F, Ruggiero M, Piano M, Gabrieli JD, Da Ros V, Romano DG, Cavallini A, Salsano G, Panni P, Limbucci N, Caragliano AA, Russo R, Bigliardi G, Milonia L, Semeraro V, Lozupone E, Cirillo L, Clarençon F, Zini A, and Broccolini A

Abstract

Background and Purpose: Mechanical thrombectomy (MT) along with emergent carotid stent placement (eCAS) has been suggested to have a greater benefit in patients with tandem lesions (TL), compared with other strategies of treatment. Nonetheless, there is no agreement on whether the intracranial occlusion should be treated before the cervical ICA lesion, or vice versa. In this retrospective multicenter study, we sought to compare clinical and procedural outcomes of the 2 different treatment approaches in patients with TL., Materials and Methods: The prospective databases of 17 comprehensive stroke centers were screened for consecutive patients with TL who received MT and eCAS. Patients were divided in 2 groups based on whether they received MT before eCAS (MT-first approach) or eCAS before MT (eCAS-first approach). Propensity score matching was used to estimate the effect of the retrograde-versus-anterograde approach on procedure-related and clinical outcome measures. These included the modified TICI score 2b-3, other procedure-related parameters and adverse events after the endovascular procedure, and the ordinal distribution of the 90-day mRS scores., Results: A total of 295 consecutive patients were initially enrolled. Among them, 208 (70%) received MT before eCAS. After propensity score matching, 56 pairs of patients were available for analysis. In the matched population, the MT-first approach resulted in a higher rate of successful intracranial recanalization (91% versus 73% in the eCAS-first approach, P  = .025) and a mean shorter groin-to-reperfusion time (72 [SD, 38] minutes versus 93 [SD, 50] minutes in the anterograde approach, P  = .017). Despite a higher rate of efficient recanalization in the MT-first group, we did not observe a significant difference regarding the ordinal distribution of the 90-day mRS scores. Rates of procedure-related adverse events and the occurrence of both parenchymal hemorrhage types 1 and 2 were comparable., Conclusions: Our study demonstrates that in patients with TL undergoing endovascular treatment, prioritizing the intracranial occlusion is associated with an increased rate of efficient MT and faster recanalization time. However, this strategy does not have an advantage in long-term clinical outcome. Future controlled studies are needed to determine the optimal treatment technique., (© 2025 by American Journal of Neuroradiology.)

Published
2024
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48. Off-Label use of Woven EndoBridge device for intracranial brain aneurysm treatment: Modeling of occlusion outcome.

Author

Essibayi MA, Jabal MS, Musmar B, Adeeb N, Salim H, Aslan A, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, Naamani KE, Shotar E, Premat K, Möhlenbruch M, Kral M, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, Yavuz K, Gunes YC, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Starke RM, Hassan A, Ogilvie M, Nguyen A, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Diestro JDB, Pukenas B, Burkhardt JK, Huynh T, Gutierrez JCM, Sheth SA, Spiegel G, Tawk R, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Haranhalli N, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Clarençon F, Limbucci N, Cuellar-Saenz HH, Jabbour PM, Pereira VM, Patel AB, Altschul D, and Dmytriw AA

Subjects
Humans, Male, Female, Retrospective Studies, Middle Aged, Treatment Outcome, Aged, Risk Factors, Blood Vessel Prosthesis, Prosthesis Design, Decision Support Techniques, Blood Vessel Prosthesis Implantation instrumentation, Blood Vessel Prosthesis Implantation adverse effects, Adult, Clinical Decision-Making, Risk Assessment, Intracranial Aneurysm therapy, Intracranial Aneurysm diagnostic imaging, Machine Learning, Endovascular Procedures instrumentation, Endovascular Procedures adverse effects, Off-Label Use
Abstract

Introduction: The Woven EndoBridge (WEB) device is emerging as a novel therapy for intracranial aneurysms, but its use for off-label indications requires further study. Using machine learning, we aimed to develop predictive models for complete occlusion after off-label WEB treatment and to identify factors associated with occlusion outcomes., Methods: This multicenter, retrospective study included 162 patients who underwent off-label WEB treatment for intracranial aneurysms. Baseline, morphological, and procedural variables were utilized to develop machine-learning models predicting complete occlusion. Model interpretation was performed to determine significant predictors. Ordinal regression was also performed with occlusion status as an ordinal outcome from better (Raymond Roy Occlusion Classification [RROC] grade 1) to worse (RROC grade 3) status. Odds ratios (OR) with 95 % confidence intervals (CI) were reported., Results: The best performing model achieved an AUROC of 0.8 for predicting complete occlusion. Larger neck diameter and daughter sac were significant independent predictors of incomplete occlusion. On multivariable ordinal regression, higher RROC grades (OR 1.86, 95 % CI 1.25-2.82), larger neck diameter (OR 1.69, 95 % CI 1.09-2.65), and presence of daughter sacs (OR 2.26, 95 % CI 0.99-5.15) were associated with worse aneurysm occlusion after WEB treatment, independent of other factors., Conclusion: This study found that larger neck diameter and daughter sacs were associated with worse occlusion after WEB therapy for aneurysms. The machine learning approach identified anatomical factors related to occlusion outcomes that may help guide patient selection and monitoring with this technology. Further validation is needed., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Published
2024
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49. Defining ideal middle cerebral artery bifurcation aneurysm size for Woven EndoBridge embolization.

Author

Adeeb N, Musmar B, Salim HA, Aslan A, Alla A, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Dibas M, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, Naamani KE, Shotar E, Premat K, Möhlenbruch M, Kral M, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano JS, Waqas M, Tutino VM, Ibrahim MK, Mohammed MA, Ozates MO, Ayberk G, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan A, Ogilvie M, Nguyen A, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Diestro JDB, Pukenas B, Burkhardt JK, Domingo RA, Huynh T, Martinez-Gutierrez JC, Essibayi MA, Sheth SA, Spiegel G, Tawk RG, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Altschul D, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Clarençon F, Limbucci N, Cuellar-Saenz HH, Jabbour PM, Mendes Pereira V, Patel AB, and Dmytriw AA

Abstract

Objective: The Woven EndoBridge (WEB) device was approved to treat wide-necked bifurcation aneurysms. The device is designed as an intrasaccular flow disruptor covering aneurysm widths up to 10 mm. Although prior studies combined all aneurysm sizes, it is known that aneurysms behave differently in response to endovascular treatment based on their size. Therefore, the authors' objective was to identify ideal middle cerebral artery (MCA) aneurysm width and neck sizes most suitable for WEB treatment., Methods: The WorldWideWEB consortium is a large multicenter retrospective database that analyzes intracranial aneurysms treated with the WEB device. In this study, all unruptured MCA bifurcation aneurysms with available measurements were included. Cutoff values based on aneurysm width and neck in relation to aneurysm occlusion status were measured using the receiver operating characteristic (ROC) curve. Propensity score matching (PSM) was then used to compare treatment outcomes between aneurysms smaller and larger than the cutoff value for both width and neck size., Results: The ideal cutoff values for MCA bifurcation aneurysm width and neck were 6.1 mm and 4.6 mm, respectively. On PSM, 87 matched pairs were compared based on width size (≤ 6.1 mm and > 6.1 mm), and 77 matched pairs were compared based on neck size (≤ 4.6 mm and > 4.6 mm). There was a significant difference in adequate aneurysm occlusion between aneurysms smaller and larger than those cutoff values for both widths (93% vs 76%, p = 0.0017) and neck sizes (90% vs 70%, p = 0.0026). The retreatment rate was also significantly higher for larger aneurysms in both parameters., Conclusions: This study shows that MCA bifurcation aneurysms ≤ 6.1 mm in width and ≤ 4.6 mm in neck size are significantly better candidates for WEB treatment, leading to improved occlusion status and reduced retreatment rate, which are important considerations when using WEB devices.

Published
2024
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50. Outcomes of Mechanical Thrombectomy in Patients With Acute Basilar Artery Occlusion With Mild to Moderate Symptoms.

Author

Nicolini E, Pracucci G, Ciacciarelli A, Saia V, Limbucci N, Nencini P, Ruggiero M, Longoni M, Cosottini M, Orlandi G, Bergui M, Cerrato P, Vallone S, Bigliardi G, Cioni S, Tassi R, Da Ros V, Diomedi M, Simonetti L, Zini A, Velo M, La Spina P, Castellan L, Del Sette M, De Michele M, Lorenzano S, Casetta I, Fainardi E, Sallustio F, Menozzi R, Pezzini A, Romano DG, Frauenfelder G, Nappini S, Loizzo N, Saletti A, De Vito A, Augelli R, Cappellari M, Zimatore DS, Petruzzellis M, Allegretti L, Tassinari T, Ajello D, Marcheselli S, Ganimede MP, Boero G, Mangiafico S, Ahmed N, Toni D, and Cereda CW

Subjects
Humans, Male, Female, Aged, Middle Aged, Treatment Outcome, Aged, 80 and over, Thrombolytic Therapy methods, Severity of Illness Index, Endovascular Procedures methods, Mechanical Thrombolysis, Fibrinolytic Agents therapeutic use, Fibrinolytic Agents administration & dosage, Vertebrobasilar Insufficiency surgery, Vertebrobasilar Insufficiency therapy, Thrombectomy methods, Ischemic Stroke therapy, Ischemic Stroke surgery, Registries
Abstract

Background and Objectives: The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) with basilar artery occlusion (BAO) and a baseline National Institute of Health Stroke Scale (NIHSS) score <10 is unclear because this subpopulation has been substantially excluded from large clinical trials. The aim of our study was to determine whether MT ± IV thrombolysis (IVT) improves functional outcomes compared with IVT alone in patients with BAO and a NIHSS score <10., Methods: We emulated a hypothetical trial including adult patients with BAO, a baseline NIHSS score <10, and prestroke modified Rankin scale (mRS) scores 0-2, comparing MT (±IVT) with IVT alone. We acquired data from patients receiving MT (±IVT) within 24 hours of onset from the Italian Registry of Endovascular Treatment in Acute Stroke and data from patients treated only with IVT within 9 hours of symptom onset from the SITS International Stroke Thrombolysis Register, from 2011 until 2021. We used inverse probability weighting (IPW) adjusted for prespecified covariates to weight each individual's contribution to the outcome. The primary outcome was 90-day mRS scores 0-2. Secondary outcomes included 90-day mRS scores 0-1, 90-day mRS scores 4-5, mortality at 90 days, in-hospital death, and symptomatic intracerebral hemorrhage., Results: Among the 764 patients recruited from the 2 databases (477 men [62.4%]; mean age [±SD] 67.88 [±13.9] years), 410 (53.7%) received MT±IVT and 354 (46.3%) only IVT. After applying IPW, our population was composed of 710 MT and 707 IVT patients. Of these, 454 MT-treated (63.9%) and 383 IVT-treated (54.2%) patients had a 90-day mRS score of 0-2 (adjusted odds ratio (aOR) 1.56 [95% CI 1.04-2.03]). MT was also associated with a higher rate of mRS scores 0-1 (aOR 2.01 [95% CI 1.37-2.95]) and a lower rate of in-hospital death (aOR 0.45 [95% CI 0.25-0.78]). Among the subgroups tested, MT had a larger effect on 90-day mRS scores 0-2 for patients with NIHSS scores 6-9 than for patients with a NIHSS score <6 ( p for interaction 0.02)., Discussion: In a large-scale target trial emulation on patients with stroke from BAO and a NIHSS score <10, MT was associated with better functional outcomes compared with IVT alone. Further research is needed to confirm the benefit of MT in patients with a NIHSS score <6., Classification of Evidence: This study provides Class III evidence that MT ± intravenous thrombolysis is associated with better 90-day functional outcomes in patients with BAO and a NIHSS score < 10 compared with intravenous thrombolysis alone.

Published
2024
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