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1. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Author: Abdelhamid, N, Abdul Rahman, D, Abdul-Saheb, M, Abreu, P, Abroskina, M, Abu Ahmad, F, Accassat, S, Acciaresi, M, Adami, A, Ahmad, N, Ahmed, F, Alberto Hawkes, M, Alemseged, F, Ali, A, Altavilla, R, Alwis, L, Amarenco, P, Amaro, S, Amaya Sanchez, LE, Amelia Pinto, A, Ameriso, SF, Amin, H, Amino, T, Amjad, AK, Anagnostou, E, Andersen, G, Anderson, C, Anderson, DC, Andrea Falco, M, Andres Mackinnon, F, Andreu, D, Androulakis, M, Angel Gamero, M, Angel Saredo, G, Angeles Diaz, R, Angels Font, M, Anticoli, S, Arauz, A, Arauz Gongora, AA, Araya, P, Arenillas Lara, JF, Arias Rivas, S, Arnold, M, Augustin, S, Avelar, W, Azevedo, E, Babikian, V, Bacellar, A, Badalyan, K, Bae, HJ, Baez Martinez, EM, Bagelmann, H, Bailey, P, Bak, Z, Baker, M, Balazs, A, Baldaranov, D, Balogun, I, Balueva, T, Bankuti, Z, Bar, M, Baranowska, A, Bardutzky, J, Barker Trejo, S, Barlinn, J, Baronnet, F, Barroso, C, Barteys, M, Bartolottiova, T, Barulin, A, Bas, M, Bashir, S, Basile, V, Bathe-Peters, R, Bathula, R, Batista, C, Batur Caglayan, H, Baumgartner, P, Bazan, R, Bazhenova, O, Beaudry, M, Beer, J, Behnam, Y, Beilei, C, Beinlich, A, Bejot, Y, Belkin, A, Benavente, OR, Benjamin, A, Berardi, V, Bereczki, D, Berkowitz, SD, Berlingieri, J, Berrios, W, Berrouschot, J, Bhandari, M, Bhargavah, M, Bicker, H, Bicsak, T, Bilik, M, Bindila, D, Birchenall, J, Birnbaum, L, Black, T, Blacker, D, Blacquiere, D, Blanc-Labarre, C, Blank, C, Blazejewska-Hyzorek, B, Bloch, S, Bodiguel, E, Bogdanov, E, Boos, L, Borcsik, L, Bornstein, N, Bouly, S, Braga, G, Bragado, I, Bravi, MC, Brokalaki, C, Brola, W, Brouns, R, Bruce, D, Brzoska-Mizgalska, J, Buck, B, Buksinska-Lisik, M, Burke, J, Burn, M, Bustamante, G, Cabrejo, L, Cai, K, Cajaraville, S, Calejo, M, Calvet, D, Campillo, J, Campos Costa, E, Camps, P, Can Alaydin, H, Candeloro, E, Canepa, C, Cantu Brito, CG, Cappellari, M, Carcel, C, Cardona Portela, P, Cardoso, F, Carek, M, Carletti, M, Carlos Portilla, J, Caruso, P, Casado-Naranjo, I, Castellini, P, Castro, D, Castro Meira, F, Cavallini, A, Cayuela Caudevilla, N, Cenciarelli, S, Cereda, C, Cerrone, P, Chakrabarti, A, Chaloulos-Iakovidis, P, Chamorro, A, Chandrasena, D, Chang, DI, Che, C, Chembala, J, Chen, J, Chen, Z, Chen, T, Chen, H, Chen, X, Chen, G, Chen, L, Chen, S, Cheripelli, B, Chin, M, Chiquete Anaya, E, Chorazy, M, Christensen, H, Christensen, T, Christian, L, Chu, F, Chung, CS, Clark, W, Clarke, R, Claverie, S, Clemente Agostoni, E, Clissold, B, Coelho, J, Cohen, D, Colakoglu, S, Collas, D, Condurso, R, Connolly, SJ, Consoli, D, Constantin, C, Constantino Silva, AB, Contardo, L, Corlobe, A, Correia, M, Correia, C, Cortijo Garcia, E, Coull, B, Coutts, S, Coveney, S, Cras, P, Crols, R, Crozier, S, Csanyi, A, Csiba, L, Csontos, K, Csuha, R, Cui, L, Cunha, L, Curtze, S, Czerska, M, Czlonkowska, A, Czurko, M, Czuryszkiewicz, M, Dagnino, M, Dai, C, Daineko, A, Dalek, G, Damgaard, D, Danese, A, Dani, K, Danku, V, Dario Toledo, W, Dávalos, A, De Havenon, A, De Keyser, J, De Klippel, N, De La Torre, J, De Pauw, A, De Smedt, A, De Torres, R, De Vries Basson, MM, Dearborn, J, Deganutto, R, Degeorgia, M, Deguchi, I, Del Giudice, A, Delcourt, C, Delgado-Mederos, R, Della Marca, G, Delpont, B, Deltour, S, Demets, DL, Dennis, M, Desai, J, Devine, J, Dhollander, I, Di Mascio, MT, Diaconu, M, Diaz Otero, F, Dietzel, J, Diez-Tejedor, E, Ding, N, Ding, J, Diomedi, M, Dioszeghy, P, Distefano, M, Domigo, V, Dorodnicov, E, Dossi, D, Doubal, F, Druzenko, I, Du, P, Du, J, Duman, T, Duodu, Y, Dutta, D, Dylewicz, L, Eckstein, J, Ehrensperger, E, Ehrlich, S, Einer Allende, G, Elena Halac, B, Elyas, S, Endres, M, Engelbrecht, JM, Engelter, S, Epinat, M, Eren, F, Esbjornsson, M, Escribano, B, Escudero, I, Esisi, B, Essa, B, Esterbauer, M, Evans, N, Eveson, D, Fabio, S, Fang, L, Fanta, S, Fares, M, Fatar, M, Faust, K, Favate, A, Fazekas, F, Federica Denaro, M, Fedin, A, Felipe Amaya, P, Feng, J, Ferencova, K, Fernanda Gilli, M, Fernandez, MD, Fernandez Pirrone, PN, Fernandez Vera, J, Ferrari, J, Ferreira, A, Ferreira Junior, G, Fidler, M, Field, D, Field, T, Figueroa, C, Fiksa, J, Filipov, A, Firstenfeld, A, Fisch, L, Fischer, U, Fisselier, M, Fiszer, U, Fluri, F, Fortea, G, Fotherby, K, Fraczek, A, France, E, Freitas, G, Frey, S, Frick, M, Friedman, A, Friedrich, M, Frisullo, G, Fryze, W, Fuentes Gimeno, B, Fujigasaki, H, Fukuyama, K, Furlan, A, Furlanis, G, Furnace, J, Gabriel, M, Gabriel Reich, E, Gagliardi, RJ, Galati, F, Galli Giqueauk, E, Gallina, A, Gallinella, E, Gallo, J, Gangadharan, S, Gao, Y, Garcia Lopez, R, Garcia Pastor, A, Garcia Sanchez, SM, Garnauf, M, Garnier, P, Gasecki, D, Gasic, K, Gasiorek, K, Gasser, S, Gaugg, M, Gebreyohanns, M, Gebura, K, Geng, J, Geniz Clavijo, M, Georg Haeusler, K, Geran, R, Geremek, M, Gerocs, Z, Ghia, D, Giannandrea, D, Giatsidis, F, Gien Lopez, JA, Gil Nunez, A, Gimenez, L, Giralt, E, Glabinski, A, Gladstone, D, Gliem, M, Gluszkiewicz, M, Goddeau, R, Gogoleva, E, Gokce, M, Goldemund, D, Golikov, K, Gomes Neto, A, Gomez Schneider, M, Gomez-Choco, M, Gomis, M, Gongora-Rivera, JF, Gonysheva, Y, Gonzalez, L, Gonzalez Toledo, ME, Gottschal, M, Gozdzik, I, Grabowski, S, Graf, S, Green, D, Greer, D, Gregorio, T, Greisenegger, S, Greshnova, I, Griebe, M, Grzesik, M, Guan, J, Guarda, S, Gueguen, A, Guidoux, C, Guillermo Povedano, P, Guillon, B, Guiraudg, V, Gunathilagan, G, Guryanova, N, Gusev, V, Gustavo Persi, G, Gutiérrez, R, Guyler, P, Gyuker, N, Hachinski, V, Hajas, A, Hallevi, H, Hankey, G, Hankey, GJ, Hanouskova, L, Hao, L, Haraguchi, K, Haralur Sreekantaiah, Y, Haratz, S, Hargroves, D, Harkness, K, Harmel, P, Harrasser, M, Hart, RG, Harvey, M, Hasan, R, Hasegawa, Y, Hassan, A, Hattori, M, Hatzitolios, A, Hauk, M, Hayashi, T, Hayhoe, H, Hedna, VS, Heine, M, Held, V, Hellwig, S, Henkner, J, Henninger, N, Hermans, S, Hernandez, J, Herrero, D, Hervieu-Begue, M, Herzig, R, Hicken, L, Hieber, M, Hill, M, Hirose, M, Hobeanu, MC, Hobson, B, Hochstetter, M, Hoe Heo, J, Hoffmann, M, Holmstedt, C, Hon, P, Hong, KS, Honma, Y, Horev, A, Horgan, G, Horvath, L, Horvath, M, Hoyer, C, Huang, D, Huang, H, Huber, B, Huhtakangas, J, Hussain, M, Igarashi, S, Iglesias Mohedano, AM, Ignacio Tembl, J, Impellizzeri, M, Inanc, Y, Ioli, P, Irina Aniculaesei, A, Ishida, K, Itabashi, R, Iversen, H, Jagolino, A, Jakab, K, Jander, S, Janka, H, Jankovych, J, Jansen, J, Jasek, L, Javier Alet, M, Javor, L, Jin, X, Jing, P, Joachim, B, Joan Macleod, M, Johnson, M, Jose Martin, J, Joyner, C, Judit Szabo, K, Jun-Oconnell, A, Jura, R, Kaczorowska, B, Kadlcikova, J, Kahles, T, Kakaletsis, N, Kakuk, I, Kalinowska, K, Kaminska, K, Kaneko, C, Kanellos, I, Kapeller, P, Kapica-Topczewska, K, Karasz, O, Karlinski, M, Karlsson, JE, Kasa, K, Kashaeva, E, Kasner, SE, Kaste, M, Kasza, J, Katalin Iljicsov, A, Katsurayama, M, Kaur, S, Kawanishi, M, Kaygorodtseva, S, Ke, K, Kei, A, Keilitz, J, Kellner, J, Kelly, P, Kelly, S, Kemlink, D, Kerekgyarto, M, Keskinarkaus, I, Khairutdinova, D, Khanna, A, Khaw, A, Kholopov, M, Khoumri, C, Kirpicheva, S, Kirshner, H, Kitagawa, K, Kittner, S, Kivioja, R, Klein, F, Kleindorfer, D, Kleinig, T, Klivenyi, P, Knecht, S, Kobayashi, Y, Kobayashi, A, Koch, M, Koehler, L, Koivu, M, Kolianov, V, Koltsov, I, Kondo, T, Konkov, I, Kopecky, S, Korompoki, E, Korpela, J, Kosarz-Lanczek, K, Koutroubi, A, Kovacs, K, Kovacs, T, Kovacs, H, Kowalczyk, K, Kowalska, M, Krajickova, D, Kral, M, Krarup Hansen, C, Kraska, J, Krebs, S, Krejci, V, Kremer, C, Kreuzpointer, R, Krzyzanowska, M, Kucken, D, Kulakowska, A, Kunzmann, J, Kurenkova, N, Kuris, A, Kurkowska-Jastrzebska, I, Kurtenkova, N, Kurushina, O, Kusnick, G, Kustova, M, Kuwashiro, T, Kwan Cha, J, Lago, A, Lagutenko, M, Lajos, B, Lambeck, J, Lamy, C, Landolfi, A, Lanfranconi, S, Lang, W, Lara Lezama, LB, Lara Rodriguez, B, Largo, T, Lasek-Bal, A, Latte, L, Lauer, V, Lavados, P, Le Bouc, R, Leal Cantu, R, Lechner, H, Lecouturier, K, Leder, S, Lee, J, Lee, BC, Leger, A, Leira, E, Leisse, I, Leker, R, Lembo, G, Lenskaya, L, Leyden, J, Li, G, Li, M, Li, S, Li, J, Liamis, G, Liang, H, Liang, Z, Ligot, N, Lin, H, Lindert, R, Lindgren, A, Linna, M, Litwin, T, Liu, K, Liu, X, Llull, L, Lohninger, B, Longoni, M, Loomis, C, Lopes, D, Lopez Fernandez, M, Lopez Garza, N, Lord, A, Louw, S, Lovasz, R, Lowenkopf, T, Lu, Z, Lubke-Detring, SC, Luder, R, Lujan, S, Luo, B, Lupinogina, L, Luschin, G, Lutsep, H, Lvova, A, Ly, J, Grosse, G.M., Ma, H, Ma, C, Machado, M, Machado, C, Macher, S, Machetanz, J, Macian-Montoro, F, Mackey, E, Mackey, A, Maclean, G, Maestre-Moreno, J, Magadan, A, Magyar, T, Mahagney, A, Majid, A, Majjhoo, A, Makaritsis, K, Mandzia, J, Mangas Guijarro, M, Mangion, D, Manios, E, Mann, S, Manning, L, Manno, C, Manuel Garcia, J, Maqueda, V, Mar Castellanos, M, Mar Freijo, M, Marando, C, Marcela Lepera, S, Marcos Couto, J, Maria Bruera, G, Maria Greco, L, Maria Lorenzo, A, Maria Obmann, S, Maria Roa, A, Marini, C, Marinkovic, I, Mario Sumay, G, Mario Torres, C, Marko, M, Markova, S, Markus, H, Marsh, R, Marsili, E, Marta Esnaola, M, Marta Moreno, J, Marti-Fabregas, J, Martina Angelocola, S, Martínez Sánchez, P, Martinez-Majander, N, Martins, S, Marzelik, O, Mastrocola, S, Matamala, G, Matoltsy, A, Matosevic, B, Matsumoto, S, Maud, A, Mauri Cabdevila, G, May, Z, Mayasi, Y, Mayr, A, Mazzoli, T, Mcarthur, K, Mccullough, L, Medina Pech, CE, Medlin, F, Mehdiratta, M, Mehta, S, Mehta, D, Mehta, B, Melis, M, Melnikova, E, Mendez, B, Mendonca, T, Mengual Chirifie, JJ, Menon, N, Mensch, A, Meseguer, E, Messe, S, Metcalf, K, Meyer, N, Michas, F, Micheletti, N, Mikulik, R, Milionis, H, Miller, B, Milling, T, Minelli, C, Minhas, J, Minns, M, Mircea, D, Mishra, S, Mismas, A, Mistri, A, Mitrovic, N, Miyake, H, Modrau, B, Moey, A, Molina, C, Molina, J, Molis, A, Moller, J, Molnar, S, Moniche, F, Monosi, C, Monzani, V, Moonis, M, Morais, R, Morales, L, Morales, A, Morar-Precup, D, Moreton, F, Moro, C, Morozova, E, Morton, M, Morvan, T, Morvan, E, Motko, T, Mowla, A, Mozhejko, E, Muddegowda, G, Mudhar, O, Mueller, T, Muhl, C, Muir, KW, Mundl, H, Munoz, S, Murphy, C, Murphy, S, Murtuzova, A, Musuka, T, Mutzenbach, J, Myint, M, Mysliwy, W, Naccarato, M, Naeije, G, Nagakane, Y, Natarajan, I, Navaratnam, D, Nave, A, Nazliel, B, Nedeltchev, K, Nel, J, Nell, H, Nemeth, R, Nemeth, L, Neto, O, Ng, K, Ngeh, J, Nicolas Chialvo, L, Nieminen, T, Nikkanen, M, Nikl, J, Nikoforova, M, Nishino, S, Nishiyama, Y, Njovane, X, Nogawa, S, Nombela, F, Norrving, B, Nosek, K, Nowak, B, Nowakowska-Sledz, E, Ntaios, G, Numminen, H, Nunez, F, Obadia, M, Oberndorfer, S, Obrezan, A, Ochiai, J, Oczkowski, W, O'Donnell, MJ, Odyniec, A, Oh, K, Ohira, M, Okamoto, Y, Okpala, M, Okubo, S, Olah, L, Olavarria, V, Oleszek, J, Onat Demirci, N, Ondar, V, Ongun, G, Ooyama, K, Orosz, V, Ortiz, R, Osseby, G, Österlund-Tauriala, E, Ovesen, C, Ozcekic Demirhan, S, Ozdoba-Rot, J, Ozturk, S, Ozyurt, E, Pablo Grecco, M, Pablo Povedano, G, Paciaroni, M, Padiglioni, C, Pagola, J, Palasik, W, Panczel, G, Panos, L, Papadopoulos, G, Papadopoulou, E, Papagiannis, A, Papavasileiou, V, Papina, M, Pardo De Donlebun, JR, Parisi, V, Park, JM, Pasten, J, Patel, N, Pavlik, O, Pawelczyk, M, Peacock, WF, Pei, H, Peisker, T, Pena Sedna, LF, Penn, A, Pentek, S, Pepper, E, Pereira, L, Perera, K, Perez, Y, Perez, S, Perez Leguizamon, P, Pernicka, M, Perry, R, Persico, A, Pesant, Y, Peska, S, Peters, D, Peters, G, Pettigrew, L, Phan, T, Philippi, S, Phinney, T, Pico, F, Pidal, A, Piechowski-Jozwiak, B, Pieroni, A, Pineiro, S, Piras, V, Pizova, N, Polanco, J, Polin, M, Polyakov, A, Polychronopoulou, E, Polymeris, A, Popov, D, Poppe, A, Postorino, P, Pozzerese, C, Pradhan, M, Prats, L, Prazdnichkova, E, Prendl, B, Pretorius, M, Profice, P, Prokopenko, S, Pudov, E, Pujol Lereis, V, Punzo Bravo, G, Purroy, F, Qiu, J, Qu, X, Quenardelle, V, Quesada Garcia, H, Radrizzani, L, Radtke, A, Raffelsberger, T, Ramirez Moreno, JM, Ramos-Estebanez, C, Rani, A, Rapantova, P, Rashed, K, Rasheed Nihara, A, Rasmussen, J, Redondo Robles, L, Reif, M, Reiner, P, Rekova, P, Renu, A, Repetto, M, Reyes, P, Reyes Morales, S, Rha, JH, Ribeiro, J, Ricci, S, Richard, C, Rigual, R, Rinaldi, C, Riveira Rodriguez, C, Rizzato, B, Robinson, TG, Rocco, A, Rodrigues, M, Rodriguez, G, Rodriguez Campello, A, Rodriguez Lucci, F, Rodriguez Yanez, M, Roesler, C, Roffe, C, Roine, R, Roine, S, Roldan, A, Romana Pezzella, F, Romano, M, Roos, JS, Rosso, C, Rostrup Kruuse, C, Roth, Y, Roukens, R, Roveri, L, Rozanski, D, Rozniecki, J, Rozsa, C, Rudilosso, S, Ruiz Ares, G, Ruiz Franco, A, Rum, G, Ruuskanen, J, Rybinnik, I, Ryota, K, Saarinen, J, Saavedra, V, Sabben, C, Sabet, A, Sagris, D, Sahlas, J, Sakai, N, Salamanca, P, Salgado, P, Salig, S, Salletmayr, T, Salnikov, M, Samoshkina, O, Samson, Y, Sanak, D, Sànchez Cerón, M, Santalucia, P, Santamaria Cadavid, M, Santiago, P, Santo, G, Sanz Cuesta, B, Sargento, J, Sarraj, A, Sas, K, Sas, A, Satoshi, O, Satsoglou, S, Sattar, N, Savitz, S, Savopoulos, C, Saw, J, Sawicka, M, Sawyer, R, Scandura, T, Schillinger, N, Schindler, J, Schlachetzki, F, Schneider, I, Schuppner, R, Schurig, J, Schwarzbach, CJ, Sebejova, M, Seidel, G, Sekaran, L, Selcuk, D, Selvarajah, J, Semerano, A, Semjen, J, Semushina, D, Sen, S, Seok Park, M, Serena, J, Serhat Tokgoz, O, Serles, W, Serrano, F, Sevin, M, Seynaeve, L, Shah, S, Shamalov, N, Shang, T, Sharma, M, Sharrief, A, Shazam Hussain, M, Shchukin, I, Shen, W, Shepeleva, E, Shinsuke, I, Shmonin, A, Shoamanesh, A, Shuaib, A, Shulga, A, Sibolt, G, Sibon, I, Sicilia, I, Siebert, M, Sieczkowska, E, Sila, C, Silva, AA, Silva, D, Silva, P, Silva, Y, Silvestrini, M, Simony, Z, Simpkins, A, Singh, B, Sinha, D, Sipos, I, Skoda, O, Skowron, P, Skowronska, M, Sliwinska, B, Slonkova, J, Smolkin, A, Smyth, A, Sobolewski, P, Sobota, A, Sohn, SI, Soldatov, M, Solganov, I, Soloveva, L, Solovyeva, E, Sonntag, N, Soors, P, Sorgun, M, Soriano, C, Spence, D, Spengos, K, Sposato, L, Staaf, G, Stadler, K, Stakhovskaya, L, Stamatelopoulos, K, Steinert, S, Stetkarova, I, Stiehm, M, Stocker, R, Stoinski, J, Stoll, A, Stotts, G, Stumpp, A, Sucapane, P, Suenaga, T, Sun, X, Sundararajan, S, Sung Kim, J, Suzuki, H, Svaneborg, N, Szasz, G, Szczuchniak, W, Szczyrba, S, Szegedi, N, Szekely, A, Szewczyk, Z, Szilagyi, G, Szlufik, S, Szoboszlai, K, Szpisjak, L, Sztajzel, R, Sztriha, L, Ta Wil, SE, Taggeselle, J, Takamatsu, K, Takao, M, Taki, W, Takizawa, S, Talahma, M, Tamayo, A, Tan, J, Tanne, D, Tapanainen, A, Tapiola, T, Tarasiuk, J, Tatlisumak, T, Tayal, A, Tcvetkova, S, Teal, P, Tejada Garcia, J, Tejada Meza, H, Tenora, D, Terceno, M, Terentiou, A, Tezcan, S, Thaler, D, Thomson, A, Thouvenot, E, Tiainen, M, Timberg, I, Timsit, S, Tinchon, A, Tirschwell, D, Togay Isikay, C, Tokunaga, K, Tolino, M, Toloza, C, Tomelleri, G, Tomoyuki, K, Tomppo, LM, Tong, Z, Tong, L, Toni, D, Torres, J, Tossavainen, C, Toth, G, Tountopoulou, A, Touze, E, Tovar, M, Toyoda, K, Trillo, S, Trommer, A, Tropepi, D, Tryambake, D, Tu, H, Tuetuencue, S, Tumova, R, Tumpula, O, Turc, G, Tutaj, A, Tynkkynen, J, Uchiyama, S, Uchwat, U, Uhrinyakova, L, Ulku Acar, R, Uluduz Ugurlu, D, Urra, X, Urui, S, Usero Ruiz, M, Vaclavik, D, Vahedi, K, Valikovics, A, Valpas, J, Van Acker, P, Van Daele, W, Vanderschueren, G, Vanina Jure, L, Varela, R, Varga, Z, Varvat, J, Varvyanskaya, N, Vasco Salgado, A, Vasko, P, Vass, L, Vassilopoulou, S, Vastagh, I, Vazquez, P, Vecsei, L, Veltkamp, R, Venti, M, Verdugo, M, Verocai, V, Veronica Marroquin, M, Veronica Simonsini, C, Veverka, T, Vigl, M, Vila, A, Vilar, C, Villanueva Osorio, JA, Virta, J, Vitkova, E, Voglsperger, B, Volna, J, Von Weitzel-Mudersbach, PA, Vora, N, Voznyuk, I, Wach-Klink, A, Wacongne, A, Walters, D, Wang, Y, Wang, J, Wang, L, Wang, X, Wang, W, Wang, N, Wang, D, Wang, H, Warnack, W, Wartenberg, K, Waters, R, Waters, M, Webb, T, Weber, J, Weiss, G, Weissenborn, K, Weitz, JI, Weller, B, Wen, G, Weng, G, Werner, P, Werring, D, Wester, P, Whiteley, W, Whiting, R, Wijeratne, T, Willems, C, Wilson, L, Wilson, C, Winder, T, Windt, J, Winkler, A, Winska-Tereszkiewicz, A, Wisniewska, A, Wittayer, M, Wlodek, A, Wojnarowska-Arendt, A, Wolf, M, Wolff, V, Wolter, C, Wong, A, Wook Nah, H, Worthmann, H, Wu, W, Wu, S, Wunderlich, S, Wurzinger, H, Wyse, DG, Xiao, B, Xiaopeng, W, Ximenez-Carrillo, A, Xiong, L, Xiong, Y, Xiong, W, Xu, Y, Xu, J, Xu, Z, Yalo, B, Yamada, T, Yamasaki, M, Yang, L, Yang, Y, Yang, X, Yang, Q, Yang, B, Yang, J, Yasuhiro, I, Yee Lam, M, Yegappan, C, Yip, S, Ylikallio, E, Ylikotila, P, Yongwon Jin, A, Yoon, BW, Yoshida, Y, Yperzeele, L, Yuan, H, Yuasa, H, Zalewska, J, Zanferrari, C, Zapata, E, Zboznovits, D, Zelenka, I, Zhang, C, Zhang, B, Zhang, S, Zhang, M, Zhang, X, Zhang, J, Zhao, L, Zhirnova, O, Zhou, L, Zielinska-Turek, J, Zinchenko, I, Ziomek, M, Zitzmann, A, Zweifler, R, Zwiernik, J, Kasner, Scott E, Swaminathan, Balakumar, Lavados, Pablo, Sharma, Mukul, Muir, Keith, Veltkamp, Roland, Ameriso, Sebastian F, Endres, Matthias, Lutsep, Helmi, Messé, Steven R, Spence, J David, Nedeltechev, Krassen, Perera, Kanjana, Santo, Gustavo, Olavarria, Veronica, Lindgren, Arne, Bangdiwala, Shrikant, Shoamanesh, Ashkan, Berkowitz, Scott D, Mundl, Hardi, Connolly, Stuart J, and Hart, Robert G
Published: 2018
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2. Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke

Author: Sallustio, 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

3. Oral anticoagulants in the oldest old with recent stroke and atrial fibrillation

Author: Polymeris, A. A., Macha, K., Paciaroni, M., Wilson, D., Koga, M., Cappellari, M., Schaedelin, S., Zietz, A., Peters, N., Seiffge, D. J., Haupenthal, D., Gassmann, L., De Marchis, G. M., Wang, R., Gensicke, H., Stoll, S., Thilemann, S., Avramiotis, N. S., Bonetti, B., Tsivgoulis, G., Ambler, G., Alberti, A., Yoshimura, S., Brown, M. M., Shiozawa, M., Lip, G. Y. H., Venti, M., Acciarresi, M., Tanaka, K., Mosconi, M. G., Takagi, M., Jager, R. H., Muir, K., Inoue, M., Schwab, S., Bonati, L. H., Lyrer, P. A., Toyoda, K., Caso, V., Werring, D. J., Kallmunzer, B., Engelter, S. T., Traenka, C., Hert, L., Wagner, B., Schaub, F., Meya, L., Fladt, J., Dittrich, T., Fisch, U., Volbers, B., Siedler, G., Bovi, P., Tomelleri, G., Micheletti, N., Zivelonghi, C., Emiliani, A., Parry-Jones, A., Patterson, C., Price, C., Elmarimi, A., Parry, A., Nallasivam, A., Nor, A. M., Esis, B., Bruce, D., Bhaskaran, B., Roffe, C., Cullen, C., Holmes, C., Cohen, D., Hargroves, D., Mangion, D., Chadha, D., Vahidassr, D., Manawadu, D., Giallombardo, E., Warburton, E., Flossman, E., Gunathilagan, G., Proschel, H., Emsley, H., Anwar, I., Burger, I., Okwera, J., Putterill, J., O'Connell, J., Bamford, J., Corrigan, J., Scott, J., Birns, J., Kee, K., Saastamoinen, K., Pasco, K., Dani, K., Sekaran, L., Choy, L., Iveson, L., Mamun, M., Sajid, M., Cooper, M., Burn, M., Smith, M., Power, M., Davis, M., Smyth, N., Veltkamp, R., Sharma, P., Guyler, P., O'Mahony, P., Wilkinson, P., Datta, P., Aghoram, P., Marsh, R., Luder, R., Meenakishundaram, S., Subramonian, S., Leach, S., Ispoglou, S., Andole, S., England, T., Manoj, A., Harrington, F., Rehman, H., Sword, J., Staals, J., Mahawish, K., Harkness, K., Shaw, L., Mccormich, M., Sprigg, N., Mansoor, S., Krishnamurthy, V., Giustozzi, M., Agnelli, G., Becattini, C., D'Amore, C., Cimini, L. A., Bandini, F., Liantinioti, C., Chondrogianni, M., Yaghi, S., Furie, K. L., Tadi, P., Zedde, M., Abdul-Rahim, A. H., Lees, K. R., Carletti, M., Rigatelli, A., Putaala, J., Tomppo, L., Tatlisumak, T., Marcheselli, S., Pezzini, A., Poli, L., Padovani, A., Vannucchi, V., Masotti, L., Sohn, S. -I., Lorenzini, G., Tassi, R., Guideri, F., Acampa, M., Martini, G., Ntaios, G., Athanasakis, G., Makaritsis, K., Karagkiozi, E., Vadikolias, K., Mumoli, N., Galati, F., Sacco, S., Tiseo, C., Corea, F., Ageno, W., Bellesini, M., Colombo, G., Silvestrelli, G., Ciccone, A., Lanari, A., Scoditti, U., Denti, L., Mancuso, M., Maccarrone, M., Ulivi, L., Orlandi, G., Giannini, N., Tassinari, T., De Lodovici, M. L., Rueckert, C., Baldi, A., Toni, D., Letteri, F., Pieroni, A., Giuntini, M., Lotti, E. M., Flomin, Y., Kargiotis, O., Karapanayiotides, T., Monaco, S., Baronello, M. M., Csiba, L., Szabo, L., Chiti, A., Giorli, E., Del Sette, M., Imberti, D., Zabzuni, D., Doronin, B., Volodina, V., Michel, P., Vanacker, P., Barlinn, K., Pallesen, L. -P., Barlinn, J., Deleu, D., Melikyan, G., Ibrahim, F., Akhtar, N., Gourbali, V., Todo, K., Kimura, K., Shibazaki, K., Yagita, Y., Furui, E., Itabashi, R., Terasaki, T., Shiokawa, Y., Hirano, T., Suzuki, R., Kamiyama, K., Nakagawara, J., Takizawa, S., Homma, K., Okuda, S., Okada, Y., Maeda, K., Kameda, T., Kario, K., Nagakane, Y., Hasegawa, Y., Akiyama, H., Shibuya, S., Mochizuki, H., Ito, Y., Nakashima, T., Matsuoka, H., Takamatsu, K., Nishiyama, K., Endo, K., Miyagi, T., Osaki, M., Kobayashi, J., Okata, T., Tanaka, E., Sakamoto, Y., Tokunaga, K., Takizawa, H., Takasugi, J., Matsubara, S., Higashida, K., Matsuki, T., Kinoshita, N., Ide, T., Yoshimoto, T., Ando, D., Fujita, K., Kumamoto, M., Kamimura, T., Kikuno, M., Mizoguchi, T., and Sato, T.
Subjects: Male, medicine.medical_specialty, Vitamin K, medicine.drug_class, 610 Medicine & health, Aged, 80 and over, Atrial Fibrillation, Factor Xa Inhibitors, Female, Humans, Stroke, Continuous variable, Internal medicine, 80 and over, medicine, Aged, Proportional hazards model, business.industry, Anticoagulant, Confounding, Atrial fibrillation, Patient data, medicine.disease, Oldest old, Neurology, Neurology (clinical), 610 Medizin und Gesundheit, business
Abstract: Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (≥85y = 0.65, 95%-CI [0.52, 0.81]) and < 85 years (HR = 0.79, 95%-CI [0.66, 0.95]) in simple (p interaction = 0.129), adjusted (p interaction = 0.094) or weighted (p interaction = 0.512) models. Analyses on recurrent stroke, ICH and death separately were consistent with the primary analysis, as were sensitivity analyses using age dichotomized at 90 years and as a continuous variable. DOAC had a similar net clinical benefit in patients aged ≥85 (+1.73 to +2.66) and < 85 years (+1.90 to +3.36 events/100 patient-years for ICH-weights 1.5 to 3.1). Interpretation: The favorable profile of DOAC over VKA in patients with AF and recent stroke was maintained in the oldest old. ANN NEUROL 2021.
Published: 2022
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4. Oral Anticoagulants in the Oldest Old with Recent Stroke and Atrial Fibrillation

Author: Polymeris, A.A. Macha, K. Paciaroni, M. Wilson, D. Koga, M. Cappellari, M. Schaedelin, S. Zietz, A. Peters, N. Seiffge, D.J. Haupenthal, D. Gassmann, L. De Marchis, G.M. Wang, R. Gensicke, H. Stoll, S. Thilemann, S. Avramiotis, N.S. Bonetti, B. Tsivgoulis, G. Ambler, G. Alberti, A. Yoshimura, S. Brown, M.M. Shiozawa, M. Lip, G.Y.H. Venti, M. Acciarresi, M. Tanaka, K. Mosconi, M.G. Takagi, M. Jäger, R.H. Muir, K. Inoue, M. Schwab, S. Bonati, L.H. Lyrer, P.A. Toyoda, K. Caso, V. Werring, D.J. Kallmünzer, B. Engelter, S.T. Engelter, S.T. Lyrer, P.A. Bonati, L.H. Seiffge, D.J. Traenka, C. Polymeris, A.A. Zietz, A. Peters, N. De Marchis, G.M. Thilemann, S. Avramiotis, N.S. Gensicke, H. Hert, L. Wagner, B. Schaub, F. Meya, L. Fladt, J. Dittrich, T. Fisch, U. Macha, K. Haupenthal, D. Gassmann, L. Wang, R. Stoll, S. Schwab, S. Volbers, B. Siedler, G. Kallmünzer, B. Cappellari, M. Bonetti, B. Bovi, P. Tomelleri, G. Micheletti, N. Zivelonghi, C. Emiliani, A. Parry-Jones, A. Patterson, C. Price, C. Elmarimi, A. Parry, A. Nallasivam, A. Nor, A.M. Esis, B. Bruce, D. Bhaskaran, B. Roffe, C. Cullen, C. Holmes, C. Cohen, D. Hargroves, D. Mangion, D. Chadha, D. Vahidassr, D. Manawadu, D. Giallombardo, E. Warburton, E. Flossman, E. Gunathilagan, G. Proschel, H. Emsley, H. Anwar, I. Burger, I. Okwera, J. Putterill, J. O’Connell, J. Bamford, J. Corrigan, J. Scott, J. Birns, J. Kee, K. Saastamoinen, K. Pasco, K. Dani, K. Sekaran, L. Choy, L. Iveson, L. Mamun, M. Sajid, M. Cooper, M. Burn, M. Smith, M. Power, M. Davis, M. Smyth, N. Veltkamp, R. Sharma, P. Guyler, P. O’Mahony, P. Wilkinson, P. Datta, P. Aghoram, P. Marsh, R. Luder, R. Meenakishundaram, S. Subramonian, S. Leach, S. Ispoglou, S. Andole, S. England, T. Manoj, A. Harrington, F. Rehman, H. Sword, J. Staals, J. Mahawish, K. Harkness, K. Shaw, L. McCormich, M. Sprigg, N. Mansoor, S. Krishnamurthy, V. Giustozzi, M. Acciarresi, M. Agnelli, G. Becattini, C. Alberti, A. D’Amore, C. Cimini, L.A. Bandini, F. Tsivgoulis, G. Liantinioti, C. Chondrogianni, M. Yaghi, S. Furie, K.L. Tadi, P. Zedde, M. Abdul-Rahim, A.H. Lees, K.R. Bovi, P. Carletti, M. Rigatelli, A. Cappellari, M. Putaala, J. Tomppo, L. Tatlisumak, T. Marcheselli, S. Pezzini, A. Poli, L. Padovani, A. Vannucchi, V. Masotti, L. Sohn, S.-I. Lorenzini, G. Tassi, R. Guideri, F. Acampa, M. Martini, G. Ntaios, G. Athanasakis, G. Makaritsis, K. Karagkiozi, E. Vadikolias, K. Mumoli, N. Galati, F. Sacco, S. Tiseo, C. Corea, F. Ageno, W. Bellesini, M. Colombo, G. Silvestrelli, G. Ciccone, A. Lanari, A. Scoditti, U. Denti, L. Mancuso, M. Maccarrone, M. Ulivi, L. Orlandi, G. Giannini, N. Tassinari, T. De Lodovici, M.L. Rueckert, C. Baldi, A. Toni, D. Letteri, F. Pieroni, A. Giuntini, M. Lotti, E.M. Flomin, Y. Kargiotis, O. Karapanayiotides, T. Monaco, S. Baronello, M.M. Csiba, L. Szabó, L. Chiti, A. Giorli, E. Del Sette, M. Imberti, D. Zabzuni, D. Doronin, B. Volodina, V. Michel, P. Vanacker, P. Barlinn, K. Pallesen, L.-P. Barlinn, J. Deleu, D. Melikyan, G. Ibrahim, F. Akhtar, N. Gourbali, V. Todo, K. Kimura, K. Shibazaki, K. Yagita, Y. Furui, E. Itabashi, R. Terasaki, T. Shiokawa, Y. Hirano, T. Suzuki, R. Kamiyama, K. Nakagawara, J. Takizawa, S. Homma, K. Okuda, S. Okada, Y. Maeda, K. Kameda, T. Kario, K. Nagakane, Y. Hasegawa, Y. Akiyama, H. Shibuya, S. Mochizuki, H. Ito, Y. Nakashima, T. Matsuoka, H. Takamatsu, K. Nishiyama, K. Tanaka, K. Endo, K. Miyagi, T. Osaki, M. Kobayashi, J. Okata, T. Tanaka, E. Sakamoto, Y. Tokunaga, K. Takizawa, H. Takasugi, J. Matsubara, S. Higashida, K. Matsuki, T. Kinoshita, N. Shiozawa, M. Ide, T. Yoshimoto, T. Ando, D. Fujita, K. Kumamoto, M. Kamimura, T. Kikuno, M. Mizoguchi, T. Sato, T. NOACISP-LONGTERM, Erlangen Registry, CROMIS-2, RAF, RAF-DOAC, SAMURAI-NVAF Verona Registry Collaborators
Abstract: Objective: To investigate the safety and effectiveness of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) after recent stroke in patients with atrial fibrillation (AF) aged ≥85 years. Methods: Individual patient data analysis from seven prospective stroke cohorts. We compared DOAC versus VKA treatment among patients with AF and recent stroke (
Published: 2022

5. 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

6. Bilateral internal carotid artery dissection associated with prior syphilis: a case report and review of the literature

Author: Marangi A, Moretto G, Cappellari M, Micheletti N, Tomelleri G, and Bovi P
Subjects: bilateral carotid dissection, ischemic stroke, neurosyphilis, Neurosciences. Biological psychiatry. Neuropsychiatry, Neurology. Diseases of the nervous system, RC346-429, RC321-571
Abstract: Antonio Marangi,1 Giuseppe Moretto,2 Manuel Cappellari,2 Nicola Micheletti,2 Giampaolo Tomelleri,2 Paolo Bovi2 1Section of Neurology, Department of Neurosciences, Biomedicine and Movement Sciences, Policlinico G.B Rossi, University of Verona, Verona, 2Stroke Unit, Division of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy Abstract: Bilateral internal carotid artery dissection is a rare entity, and its presentation may include cerebral ischemia. We describe the case of a 69-year-old man with ischemic stroke and radiological evidence of intimal flap of both internal carotid arteries suggestive for dissection. During the hospitalization, our patient was found positive for a previous syphilis infection. We conducted a review of the literature, with evidence of a few cases of ischemic stroke presumably related to a prior syphilis. The absence of major cardiovascular risk factors in our patient leads us to believe that an etiopathogenetic link may exist between these two conditions. Keywords: bilateral carotid dissection, ischemic stroke, neurosyphilis
Published: 2016

7. Rivaroxaban for stroke prevention after embolic stroke of undetermined source

Author: Hart, Robert G, Sharma, Mukul, Mundl, Hardi, Kasner, Scott E, Bangdiwala, Shrikant I, Berkowitz, Scott D, Swaminathan, Balakumar, Lavados, Pablo, Wang, Yongjun, Wang, Yilong, Davalos, Antonio, Shamalov, Nikolay, Mikulik, Robert, Cunha, Luis, Lindgren, Arne, Arauz, Antonio, Lang, Wilfried, Czlonkowska, Anna, Eckstein, Jens, Gagliardi, Rubens J, Amarenco, Pierre, Ameriso, Sebastian F, Tatlisumak, Turgut, Veltkamp, Roland, Hankey, Graeme J, Toni, Danilo, Bereczki, Daniel, Uchiyama, Shinichiro, Ntaios, George, Yoon, Byung-Woo, Brouns, Raf, Endres, Matthias, Muir, Keith W, Bornstein, Natan, Ozturk, Serefnur, O'Donnell, Martin J, De Vries Basson, Matthys M, Pare, Guillaume, Pater, Calin, Kirsch, Bodo, Sheridan, Patrick, Peters, Gary, Weitz, Jeffrey I, Peacock, W Frank, Shoamanesh, Ashkan, Benavente, Oscar R, Joyner, Campbell, Themeles, Ellison, Connolly, Anderson DC, Stuart J., Demets, Dl, Kaste, M, Norrving, B, Wyse, Dg, Alet, M, Allende, G, Beinlich, A, Berrios, W, Bruera, G, Castro, D, Chialvo, L, Claverie, S, Contardo, L, Couto, J, Deganutto, R, Diaz, R, Dossi, D, Esnaola, M, Falco, M, Fernandez Pirrone, P, Ferrari, J, Firstenfeld, A, Galli Giqueauk, E, Gilli, M, Gonzalez, L, Gonzalez Toledo, M, Grecco, M, Halac, B, Hawkes, M, Ioli, P, Jure, L, Klein, F, Lepera, S, Lujan, S, Mackinnon, F, Marroquin, M, Martin, J, Parisi, V, Perez Leguizamon, P, Persi, G, Povedano, P, Povedano, G, Pujol Lereis, V, Radrizzani, L, Reich, E, Repetto, M, Rodriguez Lucci, F, Romano, M, Saredo, G, Schneider, M, Simonsini, C, Sumay, G, Thomson, A, Toledo, W, Torres, C, Vila, A, Abdul Rasheed, N, Anderson, C, Bailey, P, Blacker, D, Carcel, C, Clissold, B, Delcourt, C, Field, D, Gangadharan, S, Ghia, D, Kleinig, T, Leyden, J, Ly, J, Ma, H, Mackey, E, Mishra, S, Moey, A, Musuka, T, Pepper, E, Phan, T, Sabet, A, Saw, J, Singh, B, Tryambake, D, Tu, H, Wijeratne, T, Wong, A, Augustin, S, Esterbauer, M, Garnauf, M, Gasiorek, K, Gasser, S, Gaugg, M, Greisenegger, S, Harrasser, M, Heine, M, Huber, B, Joachim, B, Kapeller, P, Krebs, S, Kreuzpointer, R, Kunzmann, J, Lechner, H, Lohninger, B, Luschin, G, Macher, S, Marko, M, Matosevic, B, Mayr, A, Mismas, A, Mitrovic, N, Mutzenbach, J, Oberndorfer, S, Obmann, S, Raffelsberger, T, Roesler, C, Salletmayr, T, Serles, W, Stadler, K, Tinchon, A, Tolino, M, Verocai, V, Vigl, M, Voglsperger, B, Weber, J, Werner, P, Windt, J, Winkler, A, Wurzinger, H, Zelenka, I, Cras, P, Crols, R, De Keyser, J, De Klippel, N, De Pauw, A, De Smedt, A, Dhollander, I, Hermans, S, Ligot, N, Maqueda, V, Maqueda Maqueda, V, Naeije, G, Seynaeve, L, Soors, P, Van Daele, W, Vanacker, P, Vanderschueren, G, Willems, C, Yperzeele, L, Avelar, W, Bacellar, A, Batista, C, Bazan, R, Braga, G, Cardoso, F, Dagnino, M, Fabio, S, Ferreira Junior, G, Freitas, G, Friedrich, M, Gomes Neto, A, Guarda, S, Katsurayama, M, Machado, M, Martins, S, Meira, F, Minelli, C, Morais, R, Moro, C, Neto, O, Polin, M, Silva, D, Weiss, G, Basile, V, Beaudry, M, Berlingieri, J, 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Coimbra [Coimbra], Department of Internal Medicine, University Hospital Basel [Basel], 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), Department of Neurological Sciences, Università degli Studi di Roma 'La Sapienza' = Sapienza University [Rome], Department of Neurology, Seoul National University Hospital, Institute of Neurosciences and Psychology [Glasgow], University of Glasgow, Neurology Department, Ichilov Medical Center, CIC Brest, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Yperzeele, Laetitia, NAVIGATE ESUS Investigators, and Selçuk Üniversitesi
Subjects: Stroke/etiology, Male, [SDV]Life Sciences [q-bio], Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Brain Ischemia, Brain ischemia, 0302 clinical medicine, DESIGN, Rivaroxaban, Hemorrhage/chemically induced, Secondary Prevention, Medicine, Factor Xa Inhibitors/adverse effects, Stroke, Rivaroxaban/adverse effects, ComputingMilieux_MISCELLANEOUS, 11 Medical and Health Sciences, Aspirin, Atrial fibrillation, General Medicine, FORAMEN OVALE CLOSURE, Middle Aged, TRIALS, Intracranial Embolism, SAFETY, Aged, Factor Xa Inhibitors, Female, Hemorrhage, Humans, Platelet Aggregation Inhibitors, Medicine (all), Cardiology, Foramen ovale closure, Platelet aggregation inhibitor, Settore MED/26 - Neurologia, Life Sciences & Biomedicine, medicine.drug, medicine.medical_specialty, Platelet Aggregation Inhibitors/adverse effects, ANTITHROMBOTIC THERAPY, Aspirin/adverse effects, WARFARIN, 03 medical and health sciences, Secondary Prevention/methods, Medicine, General & Internal, Internal medicine, Intracranial Embolism/drug therapy, General & Internal Medicine, NAVIGATE ESUS Investigators, METAANALYSIS, Science & Technology, CRYPTOGENIC STROKE, business.industry, Warfarin, medicine.disease, EFFICACY, ATRIAL-FIBRILLATION, Human medicine, business, Brain Ischemia/prevention & control, 030217 neurology & neurosurgery, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract: WOS: 000434263000007, PubMed: 29766772, BACKGROUND Embolic strokes of undetermined source represent 20% of ischemic strokes and are associated with a high rate of recurrence. Anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, may result in a lower risk of recurrent stroke than aspirin. METHODS We compared the efficacy and safety of rivaroxaban (at a daily dose of 15 mg) with aspirin (at a daily dose of 100 mg) for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism but without arterial stenosis, lacune, or an identified cardioembolic source. The primary efficacy outcome was the first recurrence of ischemic or hemorrhagic stroke or systemic embolism in a time-to-event analysis; the primary safety outcome was the rate of major bleeding. RESULTS A total of 7213 participants were enrolled at 459 sites; 3609 patients were randomly assigned to receive rivaroxaban and 3604 to receive aspirin. Patients had been followed for a median of 11 months when the trial was terminated early because of a lack of benefit with regard to stroke risk and because of bleeding associated with rivaroxaban. The primary efficacy outcome occurred in 172 patients in the rivaroxaban group (annualized rate, 5.1%) and in 160 in the aspirin group (annualized rate, 4.8%) (hazard ratio, 1.07; 95% confidence interval [CI], 0.87 to 1.33; P=0.52). Recurrent ischemic stroke occurred in 158 patients in the rivaroxaban group (annualized rate, 4.7%) and in 156 in the aspirin group (annualized rate, 4.7%). Major bleeding occurred in 62 patients in the rivaroxaban group (annualized rate, 1.8%) and in 23 in the aspirin group (annualized rate, 0.7%) (hazard ratio, 2.72; 95% CI, 1.68 to 4.39; P, BayerBayer AG; Janssen Research and Development, Supported by Bayer and Janssen Research and Development.
Published: 2018
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8. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Author: Kasner, S. E., Swaminathan, B., Lavados, P., Sharma, M., Muir, K., Veltkamp, R., Ameriso, S. F., Endres, M., Lutsep, H., Messe, S. R., Spence, J. D., Nedeltechev, K., Perera, K., Santo, G., Olavarria, V., Lindgren, A., Bangdiwala, S., Shoamanesh, A., Berkowitz, S. D., Mundl, H., Connolly, S. J., Hart, R. G., Abdelhamid, N., Abdul Rahman, D., Abdul-Saheb, M., Abreu, P., Abroskina, M., Abu Ahmad, F., Accassat, S., Acciaresi, M., Adami, A., Ahmad, N., Ahmed, F., Alberto Hawkes, M., Alemseged, F., Ali, A., Altavilla, R., Alwis, L., Amarenco, P., Amaro, S., Amaya Sanchez, L. E., Amelia Pinto, A., Amin, H., Amino, T., Amjad, A. K., Anagnostou, E., Andersen, G., Anderson, C., Anderson, D. C., Andrea Falco, M., Andres Mackinnon, F., Andreu, D., Androulakis, M., Angel Gamero, M., Angel Saredo, G., Angeles Diaz, R., Angels Font, M., Anticoli, S., Arauz, A., Arauz Gongora, A. A., Araya, P., Arenillas Lara, J. F., Arias Rivas, S., Arnold, M., Augustin, S., Avelar, W., Azevedo, E., Babikian, V., Bacellar, A., Badalyan, K., Bae, H. J., Baez Martinez, E. M., Bagelmann, H., Bailey, P., Bak, Z., Baker, M., Balazs, A., Baldaranov, D., Balogun, I., Balueva, T., Bankuti, Z., Bar, M., Baranowska, A., Bardutzky, J., Barker Trejo, S., Barlinn, J., Baronnet, F., Barroso, C., Barteys, M., Bartolottiova, T., Barulin, A., Bas, M., Bashir, S., Basile, V., Bathe-Peters, R., Bathula, R., Batista, C., Batur Caglayan, H., Baumgartner, P., Bazan, R., Bazhenova, O., Beaudry, M., Beer, J., Behnam, Y., Beilei, C., Beinlich, A., Bejot, Y., Belkin, A., Benavente, O. R., Benjamin, A., Berardi, V., Bereczki, D., Berlingieri, J., Berrios, W., Berrouschot, J., Bhandari, M., Bhargavah, M., Bicker, H., Bicsak, T., Bilik, M., Bindila, D., Birchenall, J., Birnbaum, L., Black, T., Blacker, D., Blacquiere, D., Blanc-Labarre, C., Blank, C., Blazejewska-Hyzorek, B., Bloch, S., Bodiguel, E., Bogdanov, E., Boos, L., Borcsik, L., Bornstein, N., Bouly, S., Braga, G., Bragado, I., Bravi, M. C., Brokalaki, C., Brola, W., Brouns, R., Bruce, D., Brzoska-Mizgalska, J., Buck, B., Buksinska-Lisik, M., Burke, J., Burn, M., Bustamante, G., Cabrejo, L., Cai, K., Cajaraville, S., Calejo, M., Calvet, D., Campillo, J., Campos Costa, E., Camps, P., Can Alaydin, H., Candeloro, E., Canepa, C., Cantu Brito, C. G., Cappellari, M., Carcel, C., Cardona Portela, P., Cardoso, F., Carek, M., Carletti, M., Carlos Portilla, J., Caruso, P., Casado-Naranjo, I., Castellini, P., Castro, D., Castro Meira, F., Cavallini, A., Cayuela Caudevilla, N., Cenciarelli, S., Cereda, C., Cerrone, P., Chakrabarti, A., Chaloulos-Iakovidis, P., Chamorro, A., Chandrasena, D., Chang, D. I., Che, C., Chembala, J., Chen, J., Chen, Z., Chen, T., Chen, H., Chen, X., Chen, G., Chen, L., Chen, S., Cheripelli, B., Chin, M., Chiquete Anaya, E., Chorazy, M., Christensen, H., Christensen, T., Christian, L., Chu, F., Chung, C. S., Clark, W., Clarke, R., Claverie, S., Clemente Agostoni, E., Clissold, B., Coelho, J., Cohen, D., Colakoglu, S., Collas, D., Condurso, R., Consoli, D., Constantin, C., Constantino Silva, A. B., Contardo, L., Corlobe, A., Correia, M., Correia, C., Cortijo Garcia, E., Coull, B., Coutts, S., Coveney, S., Cras, P., Crols, R., Crozier, S., Csanyi, A., Csiba, L., Csontos, K., Csuha, R., Cui, L., Cunha, L., Curtze, S., Czerska, M., Czlonkowska, A., Czurko, M., Czuryszkiewicz, M., Dagnino, M., Dai, C., Daineko, A., Dalek, G., Damgaard, D., Danese, A., Dani, K., Danku, V., Dario Toledo, W., Davalos, A., De Havenon, A., De Keyser, J., De Klippel, N., De La Torre, J., De Pauw, A., De Smedt, A., De Torres, R., De Vries Basson, M. M., Dearborn, J., Deganutto, R., Degeorgia, M., Deguchi, I., Del Giudice, A., Delcourt, C., Delgado-Mederos, R., Della Marca, Giacomo, Delpont, B., Deltour, S., Demets, D. L., Dennis, M., Desai, J., Devine, J., Dhollander, I., Di Mascio, M. 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Abstract: Background: Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial. Methods: NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE). The primary efficacy outcome was time to recurrent ischaemic stroke between treatment groups. The primary safety outcome was major bleeding, according to the criteria of the International Society of Thrombosis and Haemostasis. The primary analyses were based on the intention-to-treat population. Additionally, we did a systematic review and random-effects meta-analysis of studies in which patients with cryptogenic stroke and PFO were randomly assigned to receive anticoagulant or antiplatelet therapy. Findings: Between Dec 23, 2014, and Sept 20, 2017, 7213 participants were enrolled and assigned to receive rivaroxaban (n=3609) or aspirin (n=3604). Patients were followed up for a mean of 11 months because of early trial termination. PFO was reported as present in 534 (7·4%) patients on the basis of either TTE or TOE. Patients with PFO assigned to receive aspirin had a recurrent ischaemic stroke rate of 4·8 events per 100 person-years compared with 2·6 events per 100 person-years in those treated with rivaroxaban. Among patients with known PFO, there was insufficient evidence to support a difference in risk o
Published: 2018

9. Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial

Author: Kasner, Scott E, primary, Swaminathan, Balakumar, additional, Lavados, Pablo, additional, Sharma, Mukul, additional, Muir, Keith, additional, Veltkamp, Roland, additional, Ameriso, Sebastian F, additional, Endres, Matthias, additional, Lutsep, Helmi, additional, Messé, Steven R, additional, Spence, J David, additional, Nedeltechev, Krassen, additional, Perera, Kanjana, additional, Santo, Gustavo, additional, Olavarria, Veronica, additional, Lindgren, Arne, additional, Bangdiwala, Shrikant, additional, Shoamanesh, Ashkan, additional, Berkowitz, Scott D, additional, Mundl, Hardi, additional, Connolly, Stuart J, additional, Hart, Robert G, additional, Abdelhamid, N, additional, Abdul Rahman, D, additional, Abdul-Saheb, M, additional, Abreu, P, additional, Abroskina, M, additional, Abu Ahmad, F, additional, Accassat, S, additional, Acciaresi, M, additional, Adami, A, additional, Ahmad, N, additional, Ahmed, F, additional, Alberto Hawkes, M, additional, Alemseged, F, additional, Ali, A, additional, Altavilla, R, additional, Alwis, L, additional, Amarenco, P, additional, Amaro, S, additional, Amaya Sanchez, LE, additional, Amelia Pinto, A, additional, Ameriso, SF, additional, Amin, H, additional, Amino, T, additional, Amjad, AK, additional, Anagnostou, E, additional, Andersen, G, additional, Anderson, C, additional, Anderson, DC, additional, Andrea Falco, M, additional, Andres Mackinnon, F, additional, Andreu, D, additional, Androulakis, M, additional, Angel Gamero, M, additional, Angel Saredo, G, additional, Angeles Diaz, R, additional, Angels Font, M, additional, Anticoli, S, additional, Arauz, A, additional, Arauz Gongora, AA, additional, Araya, P, additional, Arenillas Lara, JF, additional, Arias Rivas, S, additional, Arnold, M, additional, Augustin, S, additional, Avelar, W, additional, Azevedo, E, additional, Babikian, V, additional, Bacellar, A, additional, Badalyan, K, additional, Bae, HJ, additional, Baez Martinez, EM, additional, Bagelmann, H, additional, Bailey, P, additional, Bak, Z, additional, Baker, M, additional, Balazs, A, additional, Baldaranov, D, additional, Balogun, I, additional, Balueva, T, additional, Bankuti, Z, additional, Bar, M, additional, Baranowska, A, additional, Bardutzky, J, additional, Barker Trejo, S, additional, Barlinn, J, additional, Baronnet, F, additional, Barroso, C, additional, Barteys, M, additional, Bartolottiova, T, additional, Barulin, A, additional, Bas, M, additional, Bashir, S, additional, Basile, V, additional, Bathe-Peters, R, additional, Bathula, R, additional, Batista, C, additional, Batur Caglayan, H, additional, Baumgartner, P, additional, Bazan, R, additional, Bazhenova, O, additional, Beaudry, M, additional, Beer, J, additional, Behnam, Y, additional, Beilei, C, additional, Beinlich, A, additional, Bejot, Y, additional, Belkin, A, additional, Benavente, OR, additional, Benjamin, A, additional, Berardi, V, additional, Bereczki, D, additional, Berkowitz, SD, additional, Berlingieri, J, additional, Berrios, W, additional, Berrouschot, J, additional, Bhandari, M, additional, Bhargavah, M, additional, Bicker, H, additional, Bicsak, T, additional, Bilik, M, additional, Bindila, D, additional, Birchenall, J, additional, Birnbaum, L, additional, Black, T, additional, Blacker, D, additional, Blacquiere, D, additional, Blanc-Labarre, C, additional, Blank, C, additional, Blazejewska-Hyzorek, B, additional, Bloch, S, additional, Bodiguel, E, additional, Bogdanov, E, additional, Boos, L, additional, Borcsik, L, additional, Bornstein, N, additional, Bouly, S, additional, Braga, G, additional, Bragado, I, additional, Bravi, MC, additional, Brokalaki, C, additional, Brola, W, additional, Brouns, R, additional, Bruce, D, additional, Brzoska-Mizgalska, J, additional, Buck, B, additional, Buksinska-Lisik, M, additional, Burke, J, additional, Burn, M, additional, Bustamante, G, additional, Cabrejo, L, additional, Cai, K, additional, Cajaraville, S, additional, Calejo, M, additional, Calvet, D, additional, Campillo, J, additional, Campos Costa, E, additional, Camps, P, additional, Can Alaydin, H, additional, Candeloro, E, additional, Canepa, C, additional, Cantu Brito, CG, additional, Cappellari, M, additional, Carcel, C, additional, Cardona Portela, P, additional, Cardoso, F, additional, Carek, M, additional, Carletti, M, additional, Carlos Portilla, J, additional, Caruso, P, additional, Casado-Naranjo, I, additional, Castellini, P, additional, Castro, D, additional, Castro Meira, F, additional, Cavallini, A, additional, Cayuela Caudevilla, N, additional, Cenciarelli, S, additional, Cereda, C, additional, Cerrone, P, additional, Chakrabarti, A, additional, Chaloulos-Iakovidis, P, additional, Chamorro, A, additional, Chandrasena, D, additional, Chang, DI, additional, Che, C, additional, Chembala, J, additional, Chen, J, additional, Chen, Z, additional, Chen, T, additional, Chen, H, additional, Chen, X, additional, Chen, G, additional, Chen, L, additional, Chen, S, additional, Cheripelli, B, additional, Chin, M, additional, Chiquete Anaya, E, additional, Chorazy, M, additional, Christensen, H, additional, Christensen, T, additional, Christian, L, additional, Chu, F, additional, Chung, CS, additional, Clark, W, additional, Clarke, R, additional, Claverie, S, additional, Clemente Agostoni, E, additional, Clissold, B, additional, Coelho, J, additional, Cohen, D, additional, Colakoglu, S, additional, Collas, D, additional, Condurso, R, additional, Connolly, SJ, additional, Consoli, D, additional, Constantin, C, additional, Constantino Silva, AB, additional, Contardo, L, additional, Corlobe, A, additional, Correia, M, additional, Correia, C, additional, Cortijo Garcia, E, additional, Coull, B, additional, Coutts, S, additional, Coveney, S, additional, Cras, P, additional, Crols, R, additional, Crozier, S, additional, Csanyi, A, additional, Csiba, L, additional, Csontos, K, additional, Csuha, R, additional, Cui, L, additional, Cunha, L, additional, Curtze, S, additional, Czerska, M, additional, Czlonkowska, A, additional, Czurko, M, additional, Czuryszkiewicz, M, additional, Dagnino, M, additional, Dai, C, additional, Daineko, A, additional, Dalek, G, additional, Damgaard, D, additional, Danese, A, additional, Dani, K, additional, Danku, V, additional, Dario Toledo, W, additional, Dávalos, A, additional, De Havenon, A, additional, De Keyser, J, additional, De Klippel, N, additional, De La Torre, J, additional, De Pauw, A, additional, De Smedt, A, additional, De Torres, R, additional, De Vries Basson, MM, additional, Dearborn, J, additional, Deganutto, R, additional, Degeorgia, M, additional, Deguchi, I, additional, Del Giudice, A, additional, Delcourt, C, additional, Delgado-Mederos, R, additional, Della Marca, G, additional, Delpont, B, additional, Deltour, S, additional, Demets, DL, additional, Dennis, M, additional, Desai, J, additional, Devine, J, additional, Dhollander, I, additional, Di Mascio, MT, additional, Diaconu, M, additional, Diaz Otero, F, additional, Dietzel, J, additional, Diez-Tejedor, E, additional, Ding, N, additional, Ding, J, additional, Diomedi, M, additional, Dioszeghy, P, additional, Distefano, M, additional, Domigo, V, additional, Dorodnicov, E, additional, Dossi, D, additional, Doubal, F, additional, Druzenko, I, additional, Du, P, additional, Du, J, additional, Duman, T, additional, Duodu, Y, additional, Dutta, D, additional, Dylewicz, L, additional, Eckstein, J, additional, Ehrensperger, E, additional, Ehrlich, S, additional, Einer Allende, G, additional, Elena Halac, B, additional, Elyas, S, additional, Endres, M, additional, Engelbrecht, JM, additional, Engelter, S, additional, Epinat, M, additional, Eren, F, additional, Esbjornsson, M, additional, Escribano, B, additional, Escudero, I, additional, Esisi, B, additional, Essa, B, additional, Esterbauer, M, additional, Evans, N, additional, Eveson, D, additional, Fabio, S, additional, Fang, L, additional, Fanta, S, additional, Fares, M, additional, Fatar, M, additional, Faust, K, additional, Favate, A, additional, Fazekas, F, additional, Federica Denaro, M, additional, Fedin, A, additional, Felipe Amaya, P, additional, Feng, J, additional, Ferencova, K, additional, Fernanda Gilli, M, additional, Fernandez, MD, additional, Fernandez Pirrone, PN, additional, Fernandez Vera, J, additional, Ferrari, J, additional, Ferreira, A, additional, Ferreira Junior, G, additional, Fidler, M, additional, Field, D, additional, Field, T, additional, Figueroa, C, additional, Fiksa, J, additional, Filipov, A, additional, Firstenfeld, A, additional, Fisch, L, additional, Fischer, U, additional, Fisselier, M, additional, Fiszer, U, additional, Fluri, F, additional, Fortea, G, additional, Fotherby, K, additional, Fraczek, A, additional, France, E, additional, Freitas, G, additional, Frey, S, additional, Frick, M, additional, Friedman, A, additional, Friedrich, M, additional, Frisullo, G, additional, Fryze, W, additional, Fuentes Gimeno, B, additional, Fujigasaki, H, additional, Fukuyama, K, additional, Furlan, A, additional, Furlanis, G, additional, Furnace, J, additional, Gabriel, M, additional, Gabriel Reich, E, additional, Gagliardi, RJ, additional, Galati, F, additional, Galli Giqueauk, E, additional, Gallina, A, additional, Gallinella, E, additional, Gallo, J, additional, Gangadharan, S, additional, Gao, Y, additional, Garcia Lopez, R, additional, Garcia Pastor, A, additional, Garcia Sanchez, SM, additional, Garnauf, M, additional, Garnier, P, additional, Gasecki, D, additional, Gasic, K, additional, Gasiorek, K, additional, Gasser, S, additional, Gaugg, M, additional, Gebreyohanns, M, additional, Gebura, K, additional, Geng, J, additional, Geniz Clavijo, M, additional, Georg Haeusler, K, additional, Geran, R, additional, Geremek, M, additional, Gerocs, Z, additional, Ghia, D, additional, Giannandrea, D, additional, Giatsidis, F, additional, Gien Lopez, JA, additional, Gil Nunez, A, additional, Gimenez, L, additional, Giralt, E, additional, Glabinski, A, additional, Gladstone, D, additional, Gliem, M, additional, Gluszkiewicz, M, additional, Goddeau, R, additional, Gogoleva, E, additional, Gokce, M, additional, Goldemund, D, additional, Golikov, K, additional, Gomes Neto, A, additional, Gomez Schneider, M, additional, Gomez-Choco, M, additional, Gomis, M, additional, Gongora-Rivera, JF, additional, Gonysheva, Y, additional, Gonzalez, L, additional, Gonzalez Toledo, ME, additional, Gottschal, M, additional, Gozdzik, I, additional, Grabowski, S, additional, Graf, S, additional, Green, D, additional, Greer, D, additional, Gregorio, T, additional, Greisenegger, S, additional, Greshnova, I, additional, Griebe, M, additional, Grzesik, M, additional, Guan, J, additional, Guarda, S, additional, Gueguen, A, additional, Guidoux, C, additional, Guillermo Povedano, P, additional, Guillon, B, additional, Guiraudg, V, additional, Gunathilagan, G, additional, Guryanova, N, additional, Gusev, V, additional, Gustavo Persi, G, additional, Gutiérrez, R, additional, Guyler, P, additional, Gyuker, N, additional, Hachinski, V, additional, Hajas, A, additional, Hallevi, H, additional, Hankey, G, additional, Hankey, GJ, additional, Hanouskova, L, additional, Hao, L, additional, Haraguchi, K, additional, Haralur Sreekantaiah, Y, additional, Haratz, S, additional, Hargroves, D, additional, Harkness, K, additional, Harmel, P, additional, Harrasser, M, additional, Hart, RG, additional, Harvey, M, additional, Hasan, R, additional, Hasegawa, Y, additional, Hassan, A, additional, Hattori, M, additional, Hatzitolios, A, additional, Hauk, M, additional, Hayashi, T, additional, Hayhoe, H, additional, Hedna, VS, additional, Heine, M, additional, Held, V, additional, Hellwig, S, additional, Henkner, J, additional, Henninger, N, additional, Hermans, S, additional, Hernandez, J, additional, Herrero, D, additional, Hervieu-Begue, M, additional, Herzig, R, additional, Hicken, L, additional, Hieber, M, additional, Hill, M, additional, Hirose, M, additional, Hobeanu, MC, additional, Hobson, B, additional, Hochstetter, M, additional, Hoe Heo, J, additional, Hoffmann, M, additional, Holmstedt, C, additional, Hon, P, additional, Hong, KS, additional, Honma, Y, additional, Horev, A, additional, Horgan, G, additional, Horvath, L, additional, Horvath, M, additional, Hoyer, C, additional, Huang, D, additional, Huang, H, additional, Huber, B, additional, Huhtakangas, J, additional, Hussain, M, additional, Igarashi, S, additional, Iglesias Mohedano, AM, additional, Ignacio Tembl, J, additional, Impellizzeri, M, additional, Inanc, Y, additional, Ioli, P, additional, Irina Aniculaesei, A, additional, Ishida, K, additional, Itabashi, R, additional, Iversen, H, additional, Jagolino, A, additional, Jakab, K, additional, Jander, S, additional, Janka, H, additional, Jankovych, J, additional, Jansen, J, additional, Jasek, L, additional, Javier Alet, M, additional, Javor, L, additional, Jin, X, additional, Jing, P, additional, Joachim, B, additional, Joan Macleod, M, additional, Johnson, M, additional, Jose Martin, J, additional, Joyner, C, additional, Judit Szabo, K, additional, Jun-Oconnell, A, additional, Jura, R, additional, Kaczorowska, B, additional, Kadlcikova, J, additional, Kahles, T, additional, Kakaletsis, N, additional, Kakuk, I, additional, Kalinowska, K, additional, Kaminska, K, additional, Kaneko, C, additional, Kanellos, I, additional, Kapeller, P, additional, Kapica-Topczewska, K, additional, Karasz, O, additional, Karlinski, M, additional, Karlsson, JE, additional, Kasa, K, additional, Kashaeva, E, additional, Kasner, SE, additional, Kaste, M, additional, Kasza, J, additional, Katalin Iljicsov, A, additional, Katsurayama, M, additional, Kaur, S, additional, Kawanishi, M, additional, Kaygorodtseva, S, additional, Ke, K, additional, Kei, A, additional, Keilitz, J, additional, Kellner, J, additional, Kelly, P, additional, Kelly, S, additional, Kemlink, D, additional, Kerekgyarto, M, additional, Keskinarkaus, I, additional, Khairutdinova, D, additional, Khanna, A, additional, Khaw, A, additional, Kholopov, M, additional, Khoumri, C, additional, Kirpicheva, S, additional, Kirshner, H, additional, Kitagawa, K, additional, Kittner, S, additional, Kivioja, R, additional, Klein, F, additional, Kleindorfer, D, additional, Kleinig, T, additional, Klivenyi, P, additional, Knecht, S, additional, Kobayashi, Y, additional, Kobayashi, A, additional, Koch, M, additional, Koehler, L, additional, Koivu, M, additional, Kolianov, V, additional, Koltsov, I, additional, Kondo, T, additional, Konkov, I, additional, Kopecky, S, additional, Korompoki, E, additional, Korpela, J, additional, Kosarz-Lanczek, K, additional, Koutroubi, A, additional, Kovacs, K, additional, Kovacs, T, additional, Kovacs, H, additional, Kowalczyk, K, additional, Kowalska, M, additional, Krajickova, D, additional, Kral, M, additional, Krarup Hansen, C, additional, Kraska, J, additional, Krebs, S, additional, Krejci, V, additional, Kremer, C, additional, Kreuzpointer, R, additional, Krzyzanowska, M, additional, Kucken, D, additional, Kulakowska, A, additional, Kunzmann, J, additional, Kurenkova, N, additional, Kuris, A, additional, Kurkowska-Jastrzebska, I, additional, Kurtenkova, N, additional, Kurushina, O, additional, Kusnick, G, additional, Kustova, M, additional, Kuwashiro, T, additional, Kwan Cha, J, additional, Lago, A, additional, Lagutenko, M, additional, Lajos, B, additional, Lambeck, J, additional, Lamy, C, additional, Landolfi, A, additional, Lanfranconi, S, additional, Lang, W, additional, Lara Lezama, LB, additional, Lara Rodriguez, B, additional, Largo, T, additional, Lasek-Bal, A, additional, Latte, L, additional, Lauer, V, additional, Lavados, P, additional, Le Bouc, R, additional, Leal Cantu, R, additional, Lechner, H, additional, Lecouturier, K, additional, Leder, S, additional, Lee, J, additional, Lee, BC, additional, Leger, A, additional, Leira, E, additional, Leisse, I, additional, Leker, R, additional, Lembo, G, additional, Lenskaya, L, additional, Leyden, J, additional, Li, G, additional, Li, M, additional, Li, S, additional, Li, J, additional, Liamis, G, additional, Liang, H, additional, Liang, Z, additional, Ligot, N, additional, Lin, H, additional, Lindert, R, additional, Lindgren, A, additional, Linna, M, additional, Litwin, T, additional, Liu, K, additional, Liu, X, additional, Llull, L, additional, Lohninger, B, additional, Longoni, M, additional, Loomis, C, additional, Lopes, D, additional, Lopez Fernandez, M, additional, Lopez Garza, N, additional, Lord, A, additional, Louw, S, additional, Lovasz, R, additional, Lowenkopf, T, additional, Lu, Z, additional, Lubke-Detring, SC, additional, Luder, R, additional, Lujan, S, additional, Luo, B, additional, Lupinogina, L, additional, Luschin, G, additional, Lutsep, H, additional, Lvova, A, additional, Ly, J, additional, Grosse, G.M., additional, Ma, H, additional, Ma, C, additional, Machado, M, additional, Machado, C, additional, Macher, S, additional, Machetanz, J, additional, Macian-Montoro, F, additional, Mackey, E, additional, Mackey, A, additional, Maclean, G, additional, Maestre-Moreno, J, additional, Magadan, A, additional, Magyar, T, additional, Mahagney, A, additional, Majid, A, additional, Majjhoo, A, additional, Makaritsis, K, additional, Mandzia, J, additional, Mangas Guijarro, M, additional, Mangion, D, additional, Manios, E, additional, Mann, S, additional, Manning, L, additional, Manno, C, additional, Manuel Garcia, J, additional, Maqueda, V, additional, Mar Castellanos, M, additional, Mar Freijo, M, additional, Marando, C, additional, Marcela Lepera, S, additional, Marcos Couto, J, additional, Maria Bruera, G, additional, Maria Greco, L, additional, Maria Lorenzo, A, additional, Maria Obmann, S, additional, Maria Roa, A, additional, Marini, C, additional, Marinkovic, I, additional, Mario Sumay, G, additional, Mario Torres, C, additional, Marko, M, additional, Markova, S, additional, Markus, H, additional, Marsh, R, additional, Marsili, E, additional, Marta Esnaola, M, additional, Marta Moreno, J, additional, Marti-Fabregas, J, additional, Martina Angelocola, S, additional, Martínez Sánchez, P, additional, Martinez-Majander, N, additional, Martins, S, additional, Marzelik, O, additional, Mastrocola, S, additional, Matamala, G, additional, Matoltsy, A, additional, Matosevic, B, additional, Matsumoto, S, additional, Maud, A, additional, Mauri Cabdevila, G, additional, May, Z, additional, Mayasi, Y, additional, Mayr, A, additional, Mazzoli, T, additional, Mcarthur, K, additional, Mccullough, L, additional, Medina Pech, CE, additional, Medlin, F, additional, Mehdiratta, M, additional, Mehta, S, additional, Mehta, D, additional, Mehta, B, additional, Melis, M, additional, Melnikova, E, additional, Mendez, B, additional, Mendonca, T, additional, Mengual Chirifie, JJ, additional, Menon, N, additional, Mensch, A, additional, Meseguer, E, additional, Messe, S, additional, Metcalf, K, additional, Meyer, N, additional, Michas, F, additional, Micheletti, N, additional, Mikulik, R, additional, Milionis, H, additional, Miller, B, additional, Milling, T, additional, Minelli, C, additional, Minhas, J, additional, Minns, M, additional, Mircea, D, additional, Mishra, S, additional, Mismas, A, additional, Mistri, A, additional, Mitrovic, N, additional, Miyake, H, additional, Modrau, B, additional, Moey, A, additional, Molina, C, additional, Molina, J, additional, Molis, A, additional, Moller, J, additional, Molnar, S, additional, Moniche, F, additional, Monosi, C, additional, Monzani, V, additional, Moonis, M, additional, Morais, R, additional, Morales, L, additional, Morales, A, additional, Morar-Precup, D, additional, Moreton, F, additional, Moro, C, additional, Morozova, E, additional, Morton, M, additional, Morvan, T, additional, Morvan, E, additional, Motko, T, additional, Mowla, A, additional, Mozhejko, E, additional, Muddegowda, G, additional, Mudhar, O, additional, Mueller, T, additional, Muhl, C, additional, Muir, KW, additional, Mundl, H, additional, Munoz, S, additional, Murphy, C, additional, Murphy, S, additional, Murtuzova, A, additional, Musuka, T, additional, Mutzenbach, J, additional, Myint, M, additional, Mysliwy, W, additional, Naccarato, M, additional, Naeije, G, additional, Nagakane, Y, additional, Natarajan, I, additional, Navaratnam, D, additional, Nave, A, additional, Nazliel, B, additional, Nedeltchev, K, additional, Nel, J, additional, Nell, H, additional, Nemeth, R, additional, Nemeth, L, additional, Neto, O, additional, Ng, K, additional, Ngeh, J, additional, Nicolas Chialvo, L, additional, Nieminen, T, additional, Nikkanen, M, additional, Nikl, J, additional, Nikoforova, M, additional, Nishino, S, additional, Nishiyama, Y, additional, Njovane, X, additional, Nogawa, S, additional, Nombela, F, additional, Norrving, B, additional, Nosek, K, additional, Nowak, B, additional, Nowakowska-Sledz, E, additional, Ntaios, G, additional, Numminen, H, additional, Nunez, F, additional, Obadia, M, additional, Oberndorfer, S, additional, Obrezan, A, additional, Ochiai, J, additional, Oczkowski, W, additional, O'Donnell, MJ, additional, Odyniec, A, additional, Oh, K, additional, Ohira, M, additional, Okamoto, Y, additional, Okpala, M, additional, Okubo, S, additional, Olah, L, additional, Olavarria, V, additional, Oleszek, J, additional, Onat Demirci, N, additional, Ondar, V, additional, Ongun, G, additional, Ooyama, K, additional, Orosz, V, additional, Ortiz, R, additional, Osseby, G, additional, Österlund-Tauriala, E, additional, Ovesen, C, additional, Ozcekic Demirhan, S, additional, Ozdoba-Rot, J, additional, Ozturk, S, additional, Ozyurt, E, additional, Pablo Grecco, M, additional, Pablo Povedano, G, additional, Paciaroni, M, additional, Padiglioni, C, additional, Pagola, J, additional, Palasik, W, additional, Panczel, G, additional, Panos, L, additional, Papadopoulos, G, additional, Papadopoulou, E, additional, Papagiannis, A, additional, Papavasileiou, V, additional, Papina, M, additional, Pardo De Donlebun, JR, additional, Parisi, V, additional, Park, JM, additional, Pasten, J, additional, Patel, N, additional, Pavlik, O, additional, Pawelczyk, M, additional, Peacock, WF, additional, Pei, H, additional, Peisker, T, additional, Pena Sedna, LF, additional, Penn, A, additional, Pentek, S, additional, Pepper, E, additional, Pereira, L, additional, Perera, K, additional, Perez, Y, additional, Perez, S, additional, Perez Leguizamon, P, additional, Pernicka, M, additional, Perry, R, additional, Persico, A, additional, Pesant, Y, additional, Peska, S, additional, Peters, D, additional, Peters, G, additional, Pettigrew, L, additional, Phan, T, additional, Philippi, S, additional, Phinney, T, additional, Pico, F, additional, Pidal, A, additional, Piechowski-Jozwiak, B, additional, Pieroni, A, additional, Pineiro, S, additional, Piras, V, additional, Pizova, N, additional, Polanco, J, additional, Polin, M, additional, Polyakov, A, additional, Polychronopoulou, E, additional, Polymeris, A, additional, Popov, D, additional, Poppe, A, additional, Postorino, P, additional, Pozzerese, C, additional, Pradhan, M, additional, Prats, L, additional, Prazdnichkova, E, additional, Prendl, B, additional, Pretorius, M, additional, Profice, P, additional, Prokopenko, S, additional, Pudov, E, additional, Pujol Lereis, V, additional, Punzo Bravo, G, additional, Purroy, F, additional, Qiu, J, additional, Qu, X, additional, Quenardelle, V, additional, Quesada Garcia, H, additional, Radrizzani, L, additional, Radtke, A, additional, Raffelsberger, T, additional, Ramirez Moreno, JM, additional, Ramos-Estebanez, C, additional, Rani, A, additional, Rapantova, P, additional, Rashed, K, additional, Rasheed Nihara, A, additional, Rasmussen, J, additional, Redondo Robles, L, additional, Reif, M, additional, Reiner, P, additional, Rekova, P, additional, Renu, A, additional, Repetto, M, additional, Reyes, P, additional, Reyes Morales, S, additional, Rha, JH, additional, Ribeiro, J, additional, Ricci, S, additional, Richard, C, additional, Rigual, R, additional, Rinaldi, C, additional, Riveira Rodriguez, C, additional, Rizzato, B, additional, Robinson, TG, additional, Rocco, A, additional, Rodrigues, M, additional, Rodriguez, G, additional, Rodriguez Campello, A, additional, Rodriguez Lucci, F, additional, Rodriguez Yanez, M, additional, Roesler, C, additional, Roffe, C, additional, Roine, R, additional, Roine, S, additional, Roldan, A, additional, Romana Pezzella, F, additional, Romano, M, additional, Roos, JS, additional, Rosso, C, additional, Rostrup Kruuse, C, additional, Roth, Y, additional, Roukens, R, additional, Roveri, L, additional, Rozanski, D, additional, Rozniecki, J, additional, Rozsa, C, additional, Rudilosso, S, additional, Ruiz Ares, G, additional, Ruiz Franco, A, 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Wlodek, A, additional, Wojnarowska-Arendt, A, additional, Wolf, M, additional, Wolff, V, additional, Wolter, C, additional, Wong, A, additional, Wook Nah, H, additional, Worthmann, H, additional, Wu, W, additional, Wu, S, additional, Wunderlich, S, additional, Wurzinger, H, additional, Wyse, DG, additional, Xiao, B, additional, Xiaopeng, W, additional, Ximenez-Carrillo, A, additional, Xiong, L, additional, Xiong, Y, additional, Xiong, W, additional, Xu, Y, additional, Xu, J, additional, Xu, Z, additional, Yalo, B, additional, Yamada, T, additional, Yamasaki, M, additional, Yang, L, additional, Yang, Y, additional, Yang, X, additional, Yang, Q, additional, Yang, B, additional, Yang, J, additional, Yasuhiro, I, additional, Yee Lam, M, additional, Yegappan, C, additional, Yip, S, additional, Ylikallio, E, additional, Ylikotila, P, additional, Yongwon Jin, A, additional, Yoon, BW, additional, Yoshida, Y, additional, Yperzeele, L, additional, Yuan, H, additional, Yuasa, H, additional, Zalewska, J, additional, Zanferrari, C, additional, Zapata, E, additional, Zboznovits, D, additional, Zelenka, I, additional, Zhang, C, additional, Zhang, B, additional, Zhang, S, additional, Zhang, M, additional, Zhang, X, additional, Zhang, J, additional, Zhao, L, additional, Zhirnova, O, additional, Zhou, L, additional, Zielinska-Turek, J, additional, Zinchenko, I, additional, Ziomek, M, additional, Zitzmann, A, additional, Zweifler, R, additional, and Zwiernik, J, additional
Published: 2018
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10. Ophthalmoparesis mimicking myasthenia gravis as acute manifestation of Hashimoto’s encephalopathy

Author: Mariotto, S, Bonetti, B, Donato, F, Micheletti, N, Zanoni, T, Moretto, G, and Squintani, G
Subjects: n/a
Published: 2015

11. Ophthalmoparesis Mimicking Myasthenia Gravis as Acute Manifestation of HashimotoÂ’s Encephalopathy

Author: Bonetti B, Squintani G, Micheletti N, Moretto G, Mariotto S, Zanoni T, and Donato F
Subjects: endocrine system, medicine.medical_specialty, Pathology, endocrine system diseases, business.industry, Encephalopathy, Hashimoto's encephalopathy, medicine.disease, Dermatology, Thyroiditis, Myasthenia gravis, Ophthalmoparesis, Autoimmune thyroiditis, medicine, Euthyroid, Differential diagnosis, medicine.symptom, business
Abstract: Hashimoto’s encephalopathy is a rare steroid-responsive disorder in which neuropsychological and neurological symptoms are associated with Hashimoto’s thyroiditis. Recently, it has gained attention in the differential diagnosis of encephalopathy of unknown origin, although its pathogenesis is poorly understood. The diagnosis of Hashimoto’s encephalopathy rests upon the association of autoimmune thyroiditis and neurological symptoms after excluding more common diseases, but is a serious challenge in atypical cases. We here present a patient with isolated ocular disorder as presenting and unic feature of Hashimoto’s encephalopathy that resolved with steroids therapy. Brain MRI showed non-specific white matter abnormalities; EEG and an extensive neurophysiological investigation were normal. The diagnosis in this euthyroid patient was supported by the presence of serum anti-thyroid antibodies and the identification in the CSF of anti-dimethylargininase-I and aldehyde reductase-I autoantibodies. The description of atypical cases of this rare but certainly underestimated condition is clinically important and adds relevant information for the clinical practice.
Published: 2015
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12. Decadal evolution of a very small heavily debris-covered glacier in an Alpine permafrost environment

Author: Capt, M., Bosson, Jean-Baptiste, Fischer, M., Micheletti, N., Lambiel, Christophe, Capt, M., Bosson, Jean-Baptiste, Fischer, M., Micheletti, N., and Lambiel, Christophe
Abstract: Glacier response to climate forcing can be heterogeneous and complex, depending on glacier system characteristics. This article presents the decadal evolution of the Tsarmine Glacier (Swiss Alps), a very small and heavily debris-covered cirque glacier located in the Alpine periglacial belt. Archival aerial photogrammetry and autocorrelation of orthophotos were used to compute surface elevation, volume and geodetic mass changes, as well as horizontal displacement rates for several periods between 1967 and 2012. A GPR survey allowed us to investigate glacier thickness (15 m mean) and volume (4 × 106 m3) in 2015 and to anticipate its future evolution. Different dynamics occurred in recent decades because of the heterogeneous surface characteristics. The climate-sensitive upper debris-free zone contrasts with the progressively stagnant heavily debris-covered glacier tongue. Between 1967 and 2012, the glacier lost 1/3 of its initial volume (2 × 106 m3). The average mass balance stabilised at ~−0.3 m w.e. a −1 since 1999. Compared with other local glaciers, the Tsarmine Glacier shows a particular decadal behaviour both in time (divergence of mass balance since the 2000s) and space (inverted ablation pattern). This might be explained by the combined influence of debris cover, shadow, snow redistribution and permafrost conditions on this very small glacier.
Published: 2016

13. REMOTE SENSING METHODS FOR THE INVESTIGATION OF THE EVOLUTION AND DYNAMICS OF ALPINE LANDSCAPES

Author: Micheletti, N. and Micheletti, N.
Abstract: Whilst the effects of present-day climate change are apparent in many environmental systems, much less is known about its impact upon the geomorphic systems characteristic of Alpine environments. This is an important knowledge gap because of the potential vulnerability of Alpine landscapes. The gap exists for two primary reasons: (1) observing climate forcing is challenging because it is manifest over timescales of decades to centuries, over which timescale geomorphic data are commonly scarce; and (2) the geomorphic response of landscapes to climate change can be complex, reflecting both spatially differential sensitivities to climate forcing and the effects of landscape heritage associated with historical glacial activity. Nonetheless, there is a consensus in the scientific community about the potentially high sensitivity of Alpine regions to climate change, because of the vulnerability of permafrost, glacial and nival processes to changes in atmospheric temperature and precipitation and the large amount of sediment stored on the associated hillsides. One approach to addressing this knowledge gap is to harness the power of remote sensing. A number of active and passive remote sensing methods could be employed for the reconstruction and monitoring of both whole landscapes and individual landforms. This Thesis aims to use such approaches to quantify the geomorphic dynamics of high mountain areas at the timescale of decades and so in the context of recent and rapid climate warming. It does so recognizing that both endogenous (landscape legacy) and exogenous (climatic forcing) processes may matter. To support this primary aim, a secondary aim arises: the evaluation of the potential of a number of remote sensing techniques for landscape and landform monitoring at multiple temporal and spatial scales. Thus this Thesis also tests in an Alpine setting the geomorphological potential of photogrammetric methods, using both aerial and hand-held sensors and both traditional and
Published: 2016

14. Cerebral Microbleeds in a Small Cohort of Patients with First Ever Lacunar Stroke. A 3Tesla MRI Longitudinal Case Series

Author: Gulli, G, primary, Pizzini, FB, additional, Moretto, G, additional, Beltramello, A, additional, and Micheletti, N, additional
Published: 2016
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15. Decadal evolution of a very small heavily debris-covered glacier in an Alpine permafrost environment

Author: CAPT, M., primary, BOSSON, J.-B., additional, FISCHER, M., additional, MICHELETTI, N., additional, and LAMBIEL, C., additional
Published: 2016
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16. Decadal evolution of a very small heavily debris-covered glacier in an Alpine permafrost environment

Author: Capt, M., Bosson, Jean-Baptiste, Fischer, M., Micheletti, N., Lambiel, Christophe, Capt, M., Bosson, Jean-Baptiste, Fischer, M., Micheletti, N., and Lambiel, Christophe
Abstract: Glacier response to climate forcing can be heterogeneous and complex, depending on glacier system characteristics. This article presents the decadal evolution of the Tsarmine Glacier (Swiss Alps), a very small and heavily debris-covered cirque glacier located in the Alpine periglacial belt. Archival aerial photogrammetry and autocorrelation of orthophotos were used to compute surface elevation, volume and geodetic mass changes, as well as horizontal displacement rates for several periods between 1967 and 2012. A GPR survey allowed us to investigate glacier thickness (15 m mean) and volume (4 × 106 m3) in 2015 and to anticipate its future evolution. Different dynamics occurred in recent decades because of the heterogeneous surface characteristics. The climate-sensitive upper debris-free zone contrasts with the progressively stagnant heavily debris-covered glacier tongue. Between 1967 and 2012, the glacier lost 1/3 of its initial volume (2 × 106 m3). The average mass balance stabilised at ~−0.3 m w.e. a −1 since 1999. Compared with other local glaciers, the Tsarmine Glacier shows a particular decadal behaviour both in time (divergence of mass balance since the 2000s) and space (inverted ablation pattern). This might be explained by the combined influence of debris cover, shadow, snow redistribution and permafrost conditions on this very small glacier.

17. Implementation of a protocol to prevent hypoglycemia in at-risk neonates born at 35 weeks' gestational age in a tertiary hospital: Adherence and satisfaction. It's not so easy!

Author: Suprin M, Micheletti N, Caraby SF, Ruello C, Ego A, Debillon T, Doutau J, and Chevallier M
Subjects: Humans, Infant, Newborn, Prospective Studies, Female, Male, Gestational Age, Clinical Protocols, Patient Satisfaction, Risk Factors, Blood Glucose analysis, Infant, Premature, Hypoglycemia prevention & control, Tertiary Care Centers, Guideline Adherence statistics & numerical data
Abstract: Background: The present study assessed adherence and satisfaction regarding a new protocol for preventing hypoglycemia in neonates, with a target of 80 % adherence., Methods: This 6-month prospective observational study was conducted between 2021 and 2022 in a tertiary hospital maternity unit. Neonates with at least one hypoglycemia risk factor were included. Two factors for adherence were evaluated: feeding before 1 h of life and capillary blood glucose assay at 2 h of life., Results: Protocol adherence was 67.6 % overall, with clinically satisfactory protocol application. Neonates small for gestational age were at the greatest risk of hypoglycemia (34.8 %). Non-adherence mainly concerned early feeding (28.9 %). The rate of hypoglycemia with adherence and non-adherence was, respectively, 15.8 % (n = 27/171) and 22.0 % (n = 18/82) (p = 0.23). Teams integrated the new recommendations successfully (satisfaction: 8/10), with some reluctance on the part of childcare assistants due to increased workload., Conclusion: This apparently simple protocol could be supported by a quality improvement program. This study might help other care teams to establish similar protocols and identify areas for improvement., (Copyright © 2024 Société française de pédiatrie. Published by Elsevier Masson SAS. All rights reserved.)
Published: 2024
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18. Application of the "1-2-3-4-day" rule to stroke severity at baseline versus at 24 h to start direct oral anticoagulant for atrial fibrillation within 7 days from symptom onset.

Author: Cappellari M, Emiliani A, Zivelonghi C, Micheletti N, Tomelleri G, and Bonetti B
Subjects: Humans, Anticoagulants therapeutic use, Prospective Studies, Intracranial Hemorrhages etiology, Administration, Oral, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Stroke diagnostic imaging, Stroke drug therapy, Stroke etiology
Abstract: Introduction: The aim of this study is to compare the "1-2-3-4-day" rule applied to stroke severity at baseline versus at 24 h to start DOAC for AF within 7 days from symptom onset., Patients and Methods: We conducted a prospective cohort observational study based on 433 consecutive AF-related stroke patients starting DOAC within 7 days from symptom onset. Four groups were identified according to the timing of DOAC introduction: 2-day, 3-day, 4-day, and 5-7-day., Results: Three models of multivariate ordinal regression including unbalanced variables among four groups (enrolment year, dyslipidemia, known AF, thrombolysis, thrombectomy, hemorrhagic transformation, DOAC type) were used to estimate the association of neurological severity categories (reference: NIHSS > 15) at baseline (Brant test: 0.818), at 24 h (Brant test: 0.997), and radiological severity categories (reference: major infarct) at 24 h (Brant test: 0.902) in the direction of earlier DOAC introduction on days (from 5-7-day to 2-day). Number of deaths was higher in early DOAC group than in late DOAC group according to the "1-2-3-4-day" rule (5.4% versus 1.3%, 6.8% versus 1.1%, and 4.2% versus 1.7% when it was applied to baseline neurological severity, 24-h neurological and radiological severity, respectively), but no significant difference was found and deaths were not caused by early DOAC introduction. Rates of ischemic stroke and intracranial hemorrhage were not different between early and late DOAC groups., Conclusions: The application of "1-2-3-4-day" rule to start DOAC for AF within 7 days from symptom onset differed when applied to baseline neurological stroke severity versus 24-h neurological and radiological severity, but safety and effecacy are similar., (© 2023. Fondazione Società Italiana di Neurologia.)
Published: 2023
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19. Thrombectomy for ischemic stroke with large vessel occlusion and concomitant subarachnoid hemorrhage.

Author: Zivelonghi C, Emiliani A, Augelli R, Plebani M, Micheletti N, Tomelleri G, Bonetti B, and Cappellari M
Subjects: Humans, Male, Middle Aged, Retrospective Studies, Stroke etiology, Thrombectomy, Treatment Outcome, Brain Ischemia etiology, Ischemic Stroke, Subarachnoid Hemorrhage surgery
Abstract: To report our experience in treating one patient with nontraumatic subarachnoid hemorrhage (SAH) and concurrent acute ischemic stroke (AIS) due to large vessels occlusion (LVO). A man in his 50 s presented with acute right hemiparesis and aphasia. Brain CT showed a SAH in the left central sulcus; CT-angiography revealed a tandem occlusion of the left internal carotid artery and homolateral middle cerebral artery. He underwent an angiographic procedure with successful recanalization. Follow-up CT demonstrated a striatal-lenticular stroke without SAH progression. While the absolute contraindication to IVT during intracranial bleeding remains unquestionable, the potential injury/benefit from MT is still debatable. Such cases constitute a blind spot in the guidelines where physicians face the dilemma of choosing between an acute endovascular treatment with the risks of hemorrhage progression and a conservative treatment with the associated poor clinical outcome. We decided to treat our patient invasively, considering the young age, also given the absence of prognostic factors that generally predict post-procedural reperfusion injury. We believe that, in similar cases, MT should be considered-despite not free of risks and drawbacks-to avoid the detrimental consequences of untreated AIS from LVO., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Published: 2021
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20. Artery of Percheron stroke from carotid lesion.

Author: Bajrami A, Zivelonghi C, Micheletti N, and Cappellari M
Subjects: Carotid Arteries, Cerebral Infarction, Humans, Carotid Stenosis complications, Carotid Stenosis diagnostic imaging, Stroke diagnostic imaging
Published: 2021
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21. Factors influencing cognitive performance after 1-year treatment with direct oral anticoagulant in patients with atrial fibrillation and previous ischemic stroke: a pilot study.

Author: Cappellari M, Forlivesi S, Zucchella C, Valbusa V, Sajeva G, Musso AM, Micheletti N, Tomelleri G, Bovi T, Bonetti B, and Bovi P
Subjects: Aged, Duration of Therapy, Factor Xa Inhibitors therapeutic use, Female, Heart Failure epidemiology, Humans, Hyperlipidemias epidemiology, Italy epidemiology, Male, Myocardial Ischemia epidemiology, Neuropsychological Tests, Prognosis, Risk Factors, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Cognition drug effects, Dabigatran therapeutic use, Dementia diagnosis, Dementia etiology, Dementia physiopathology, Dementia prevention & control, Ischemic Stroke complications, Ischemic Stroke diagnostic imaging, Ischemic Stroke psychology
Abstract: Anticoagulant treatment as stroke prevention, particularly direct oral anticoagulant (DOAC), may reduce the risk of dementia in patients with atrial fibrillation (AF). We aimed to assess factors influencing cognitive performance after 1-year treatment with DOAC in patients with AF and previous ischemic stroke. We recruited 33 ischemic stroke patients who were discharged from Verona Stroke Unit with diagnosis of AF and prescription of treatment with DOAC. For each cognitive test, we estimated the effect of T0 (first session) variables on T1 (1-year session) cognitive performance using ordinal logistic regression fitted to a 1 point-shift from 4 to 0 on ESs. The effect of T0 clinical variables was presented as odds ratio (OR) with 95% confidence interval (CI) after adjustment for T0 total score of the corresponding cognitive test. Sustained AF (OR: 4.259, 95% CI 1.071-16.942) and ischemic heart disease (OR: 6.654, 95% CI 1.329-33.300) showed a significant effect on T1 MoCA Test; congestive heart failure on T1 RAVLT Immediate recall (OR: 9.128, 95% CI 1.055-78.995), T1 RAVLT Delayed recall (OR: 7.134, 95% CI 1.214-52.760), and T1 Trail Making Test (Part A) (OR: 16.989, 95% CI 1.765-163.565); sustained AF (OR: 5.055, 95% CI 1.224-20.878) and hyperlipidemia (OR: 4.764, 95% CI 1.175-19.310) on T1 Digit span forward Test; ischemic heart disease (aOR: 8.460, 95% CI 1.364-52.471) on T1 Stroop Color and Word Test (time); Dabigatran use (aOR: 0.084, 95% CI 0.013-0.544) on FAB; age ≥ 75 years (aOR: 0.058, 95% CI 0.006-0.563) and hyperlipidemia (aOR: 5.809, 95% CI 1.059-31.870) on T1 Phonemic word fluency Test; female sex (aOR: 6.105, 95% CI 1.146-32.519), hyperlipidemia (aOR: 21.099, 95% CI 2.773-160.564), total Modified Fazekas Scale score > 1 (aOR: 78.530, 95% CI 3.131-1969.512) on Semantic word fluency Test. Sustained AF, ischemic heart disease, congestive heart failure, hyperlipidemia, and female sex were the factors influencing cognitive performance after 1-year treatment with DOAC in patients with AF and previous ischemic stroke. Modified Fazekas Scale score in the first session was the only radiological variable that had a significant effect on cognitive performance.
Published: 2021
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22. Vertebral Artery Fenestration Mimicking Acute Dissection.

Author: Zivelonghi C, Emiliani A, Micheletti N, and Tamburin S
Subjects: Adult, Diagnosis, Differential, Female, Humans, Vertebral Artery abnormalities, Vertebral Artery diagnostic imaging, Vertebral Artery Dissection diagnostic imaging
Published: 2020
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23. Introduction of direct oral anticoagulant within 7 days of stroke onset: a nomogram to predict the probability of 3-month modified Rankin Scale score > 2.

Author: Cappellari M, Turcato G, Forlivesi S, Micheletti N, Tomelleri G, Bonetti B, Merlino G, Eleopra R, Russo M, L'Erario R, Adami A, Gentile C, Gaudenzi A, Bruno S, and Bovi P
Subjects: Aged, Aged, 80 and over, Atrial Fibrillation complications, Female, Humans, Male, Middle Aged, Prognosis, Prospective Studies, ROC Curve, Risk Factors, Stroke drug therapy, Stroke etiology, Time Factors, Treatment Outcome, Anticoagulants therapeutic use, Nomograms, Severity of Illness Index, Stroke diagnosis
Abstract: In clinical practice, direct oral anticoagulants (DOACs) are often started earlier (≤ 7 days) than in randomized clinical trials after stroke. We aimed to develop a nomogram model incorporating time of DOAC introduction ≤ 7 days of stroke onset in combination with different degrees of stroke radiological/neurological severity at the time of treatment to predict the probability of unfavorable outcome. We conducted a multicenter prospective study including 344 patients who started DOAC 1-7 days after atrial fibrillation-related stroke onset. Computed tomography scan 24-36 h after stroke onset was performed in all patients before starting DOAC. Unfavorable outcome was defined as modified Rankin Scale (mRS) score > 2 at 3 months. Based on multivariate logistic model, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve (AUC-ROC) and calibration of risk prediction model by using the Hosmer-Lemeshow test. Onset-to-treatment time for DOAC (OR: 1.21, p = 0.030), NIH Stroke Scale (NIHSS) score at the time of treatment (OR: 1.00 for NIHSS = 0-5; OR: 2.67, p = 0.016 for NIHSS = 6-9; OR: 26.70, p < 0.001 for NIHSS = 10-14; OR: 57.48, p < 0.001 for NIHSS ≥ 15), size infarct (OR: 1.00 for small infarct; OR: 2.26, p = 0.023 for medium infarct; OR: 3.40, p = 0.005 for large infarct), and age ≥ 80 years (OR: 1.96, p = 0.028) remained independent predictors of unfavorable outcome to compose the nomogram. The AUC-ROC of nomogram was 0.858. Calibration was good (p = 2.889 for the Hosmer-Lemeshow test). The combination of onset-to-treatment time of DOAC with stroke radiological/neurological severity at the time of treatment and old age may predict the probability of unfavorable outcome.
Published: 2018
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24. The dispersion of myocardial repolarization in ischemic stroke and intracranial hemorrhage.

Author: Danese A, Cappellari M, Pancheri E, Mugnai G, Micheletti N, Tomelleri G, Carletti M, Turri G, Marafioti V, Monaco S, Bonetti B, and Bovi P
Subjects: Aged, Arrhythmias, Cardiac diagnosis, Brain Ischemia physiopathology, Diagnosis, Differential, Female, Humans, Intracranial Hemorrhages complications, Intracranial Hemorrhages diagnosis, Male, Retrospective Studies, Stroke complications, Stroke diagnosis, Arrhythmias, Cardiac etiology, Electrocardiography, Intracranial Hemorrhages physiopathology, Stroke physiopathology
Abstract: Background: Markers of dispersion of myocardial repolarization have been proposed to identify the patients at higher risk of malignant arrhythmic events. The aim of the present study is to assess a possible association of the electrocardiografic (ECG) markers of the dispersion of repolarization with the type of stroke, involvement of insula, neurological severity (National Institutes of Health Stroke Scale, NIHSS score), and disability (modified Rankin Scale, mRS score) in patients with a cerebrovascular event., Methods: We conducted a retrospective analysis based on data prospectively collected from consecutive patients with a cerebrovascular event who underwent 12‑lead ECG at admission to the Verona Stroke Unit., Results: Of the 63 patients included in the study, 55 had ischemic stroke and 8 intracranial hemorrhage. TpTe (time between the peak and the end of the T wave) and TpTe/QTc (TpTe/corrected time between the start of the Q wave and the end of the T wave) in lead V5 were higher in intracranial hemorrhage than in ischemic stroke (p = 0.03 and p = 0.04, respectively) and QT max (the longest QT calculated in the 12 leads) was higher in patients with involvement of insula (p ≤ 0.01). A correlation was found between QTc max and NIHSS score at admission (p = 0.02), QT max and NIHSS score at discharge (p = 0.05), and QT max and mRS score at discharge (p = 0.02)., Conclusions: TpTe and TpTe/QTc in V5 lead were associated with intracranial hemorrhage and QT max was associated with involvement of insula. The prolongation of QT was correlated with neurological severity and disability., (Copyright © 2018 Elsevier Inc. All rights reserved.)
Published: 2018
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25. Association of hyperglycemia, systolic and diastolic hypertension, and hyperthermia relative to baseline in the acute phase of stroke with poor outcome after intravenous thrombolysis.

Author: Forlivesi S, Micheletti N, Tomelleri G, Bovi P, and Cappellari M
Subjects: Administration, Intravenous, Female, Fever pathology, Humans, Hyperglycemia pathology, Hypertension pathology, Male, Prospective Studies, Retrospective Studies, Risk Factors, Stroke pathology, Fever etiology, Hyperglycemia etiology, Hypertension etiology, Stroke complications, Thrombolytic Therapy adverse effects
Abstract: : In the acute phase of ischemic stroke, the trend of some physiological variables, such as blood glucose (BG), blood pressure, and body temperature (BT), might influence outcome. We aimed to assess the association of hyperglycemia, systolic and diastolic hypertension, and hyperthermia relative to baseline BG, systolic blood pressure, diastolic blood pressure and BT, respectively, in the first 12 h with poor outcome after intravenous thrombolysis (IVT). We conducted a retrospective analysis of data prospectively collected from 200 consecutive anterior ischemic stroke patients treated with IVT. Outcome measures were no neurological improvement at 24 h (National Institutes of Health Stroke Scale (NIHSS) score at 24 h ≥NIHSS score at baseline), and unfavorable functional outcome [modified Rankin Scale (mRS) score 3-6] at 3 months. No neurological improvement at 24 h was noted in 52 (26%) patients and mRS 3-6 at 3 months in 68 (34%) patients. The multivariate analyses showed that odds ratios (ORs) for no neurological improvement at 24 h were higher in patients with hyperglycemia relative to baseline [OR 3.50, 95% confidence interval (CI) 1.43-8.57, P = 0.006], and hyperthermia relative to baseline (OR 2.88, 95% CI 1.20-6.91, P = 0.018). OR for 3-month mRS score 3-6 was higher in patients with hyperthermia relative to baseline (OR 3.05, 95% CI 1.20-7.74, P = 0.019). Hyperglycemia and hyperthermia relative to baseline in the first 12 h after IVT are associated with no neurological improvement at 24 h. Hyperthermia relative to baseline is also associated with unfavorable functional outcome at 3 months.
Published: 2018
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26. A nomogram to predict the probability of mortality after first-ever acute manifestations of cerebral small vessel disease.

Author: Cappellari M, Zivelonghi C, Turcato G, Forlivesi S, Micheletti N, Tomelleri G, Bovi P, and Bonetti B
Subjects: Aged, Aged, 80 and over, Electronic Health Records statistics & numerical data, Female, Glasgow Coma Scale, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Retrospective Studies, Statistics, Nonparametric, Cerebral Small Vessel Diseases mortality, Nomograms, Probability
Abstract: Background and Purpose: Symptomatic lacunar stroke (LS) and deep intracerebral hemorrhage (dICH) represent the acute manifestations of type 1 cerebral small vessel disease (cSVD). Recently, two studies showed that the risk factor profile of dICH differs from that associated with LS in subjects with biologically plausible cSVD; however, the prognostic predictors after acute manifestations are currently lacking. We aimed to develop a nomogram for individualized prediction of the mortality probability in a cohort of patients with a first-ever acute manifestation of biologically plausible cSVD., Methods: We conducted a retrospective analysis of data collected from consecutive patients with acute symptomatic non-embolic LS or primary dICH. The outcome measure was 3-month mortality. Based on multivariate logistic model, the nomogram was generated., Results: Of the 288 patients who entered into the study for biologically plausible cSVD, 131 (45%) experienced a LS and 157 (55%) a dICH. After multivariate logistic regression, 5 variables remained predictors of mortality to compose the nomogram: dICH (OR:11.36; p=0.001), severe presentation (OR:8.08; p<0.001), age (OR:1.08; p=0.001), glucose (OR:1.23; p=0.003) and creatinine (OR:1.01; p=0.024) at admission were predictors of mortality. The discriminative performance of nomogram assessed by using the area under the receiver operating characteristic curve (AUC-ROC) was 0.898. The model was internally validated by using bootstrap (1000 samples) with AUC-ROC of 0.895 and cross-validation (deleted-d method repeated 1000 times) with AUC-ROC of 0.895., Conclusions: We developed the first nomogram for prediction of the mortality probability in a cohort of patients with a first-ever acute manifestation of biologically plausible cSVD., (Copyright © 2017 Elsevier B.V. All rights reserved.)
Published: 2018
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27. Clinical outcomes of secondary prevention strategies for young patients with cryptogenic stroke and patent foramen ovale.

Author: Danese A, Stegagno C, Tomelleri G, Piccoli A, Turri G, Carletti M, Variola A, Anselmi M, Mazzucco S, Ferrara A, Bovi P, Micheletti N, Cappellari M, Monaco S, Vassanelli C, and Ribichini F
Subjects: Adult, Age Factors, Anticoagulants adverse effects, Female, Fibrinolytic Agents adverse effects, Foramen Ovale, Patent complications, Foramen Ovale, Patent diagnostic imaging, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors adverse effects, Prospective Studies, Recurrence, Risk Factors, Stroke diagnostic imaging, Stroke etiology, Time Factors, Treatment Outcome, Anticoagulants therapeutic use, Cardiac Catheterization adverse effects, Fibrinolytic Agents therapeutic use, Foramen Ovale, Patent therapy, Platelet Aggregation Inhibitors therapeutic use, Secondary Prevention methods, Stroke prevention & control
Abstract: Background The aim of this study was to compare the immediate and long-term clinical outcomes of medical therapy and percutaneous patent foramen ovale (PFO) closure as secondary prevention strategies in patients younger than 55 years of age presenting with cryptogenic stroke and PFO. Methods Between January 2006 and April 2015, all patients with the diagnosis of cryptogenic stroke and PFO were analysed and prospectively followed. Stroke was confirmed in 159 out of 309 patients (51%). In the remaining cases, other neurological conditions were found and therefore excluded from further analysis. Patients received PFO closure or medical therapy on the basis of a pre-specified algorithm. Primary outcome was the assessment of recurrent ischaemic events at follow-up. Results Percutaneous PFO closure was performed in 77 patients (48%) and 82 (52%) were treated medically. Mean follow-up was 51.6 ± 34.8 months. Two ischaemic strokes occurred in the medical group only (2.4% vs 0%; P = 0.16) and no complications related to the invasive procedure were observed. Conclusions The diagnosis of stroke in patients with PFO could be confirmed in 50% of cases only, underlining the importance of a multidisciplinary evaluation of these patients. A very low ischaemic recurrence rate was observed in the medical therapy group, suggesting that a personalized treatment based on a prespecified diagnostic algorithm yields good clinical results irrespective of the treatment modality. Given the low number of recurrences, larger cohorts may be needed to prove significant differences.
Published: 2017
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28. Stroke etiologic subtype may influence the rate of hyperdense middle cerebral artery sign disappearance after intravenous thrombolysis.

Author: Forlivesi S, Bovi P, Tomelleri G, Micheletti N, Carletti M, Moretto G, and Cappellari M
Subjects: Administration, Intravenous, Adult, Aged, Female, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents therapeutic use, Humans, Male, Middle Aged, Recovery of Function, Retrospective Studies, Treatment Outcome, Middle Cerebral Artery pathology, Stroke etiology, Thrombolytic Therapy methods
Abstract: Disappearance of hyperdense middle cerebral artery sign (HMCAS) on non-contrast brain computed tomography (CT) scan is a reliable sign of arterial recanalization after intravenous (IV) thrombolysis for ischemic stroke. We aimed to assess whether stroke etiologic subtype may influence the rate of HMCAS disappearance and the clinical outcome after IV thrombolysis. We conducted a retrospective analysis of data prospectively collected from 1031 consecutive stroke patients treated with IV thrombolysis. Outcome measures were HMCAS disappearance on follow-up CT scan within 22-36 h of IV thrombolysis, neurologic improvement (NIH Stroke Scale [NIHSS] ≤4 points from baseline or NIHSS score of 0) at 7 days, and modified rankin scale (mRS) ≤1 at 3 months. Of 256 patients with HMCAS on admission CT scan, 125 had a cardioembolic stroke, 67 a stroke due to large-artery atherosclerosis (LAA), 58 a stroke of undetermined etiology, and six a stroke secondary to carotid artery dissection. HMCAS disappearance occurred in 145 (56.6 %) patients, neurologic improvement in 122 (55.0 %) patients, and mRS ≤1 in 64 (32.8 %) patients. Compared with cardioembolic stroke patients, patients with stroke due to LAA had lower odds ratios (OR) for HMCAS disappearance (OR 0.29, 95 % CI 0.15-0.58, p < 0.001), neurologic improvement (OR 0.42, 95 % CI 0.22-0.82, p = 0.011), and mRS ≤1 (OR 0.18, 95 % CI 0.06-0.52, p = 0.002). No significant differences in outcome measures were found between cardioembolic strokes and strokes of undetermined etiology. This study suggests that stroke due to LAA is associated with lower rates of HMCAS disappearance, neurologic improvement, and mRS ≤1 after IV thrombolysis, compared with cardioembolic stroke.
Published: 2017
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29. Reasons for exclusion from intravenous thrombolysis in stroke patients admitted to the Stroke Unit.

Author: Cappellari M, Bosco M, Forlivesi S, Tomelleri G, Micheletti N, Carletti M, and Bovi P
Subjects: Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Stroke physiopathology, Stroke therapy, Thrombolytic Therapy
Abstract: Intravenous (IV) thrombolysis is the treatment in ischemic stroke, but only the minority of patients receive this medication. The primary objective of this study was to explore the reasons associated with the decision not to offer IV thrombolysis to stroke patients admitted to the Stroke Unit (SU). We conducted a retrospective analysis based on data collected from 876 consecutive stroke patients admitted to the SU <12 h of symptoms onset, treated or not with IV thrombolysis at the discretion of the treating neurologist. Of the 876 patients, 449 were thrombolysed and 427 non-thrombolysed. Stroke onset >4.5 h (p = 0.001) and unknown time of onset (or stroke present on awakening) (p = 0.004) were reasons listed in the current SPC of Actilyse reasons for exclusion even they occurred singly, whereas mild deficit (or rapidly improving symptoms) (p < 0.001), extra-cranial conditions with increased risk of bleeding (p = 0.004), and history of SNC diseases (p = 0.001) only when they occurred in combination. Severe pre-stroke disability (p = 0.003) was extra-SPC reason for exclusion even when it occurred singly, whereas early CT hypodensity (p < 0.001) only when it occurred in combination. After stratification for intra-SPC reasons for exclusion, early CT hypodensity was associated with decision not offer IV thrombolysis in patients with mild deficit (p < 0.001), age >80 years (p < 0.001), stroke onset >4.5 h (p = 0.005), and unknown time of onset (p = 0.037), while severe pre-stroke disability (p = 0.025) and admission under non-stroke specialist neurologist assessment (p = 0.018) in patients with age >80 years. There are often unjustified reasons for exclusion from IV thrombolysis in SU.
Published: 2016
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30. On Nature's Strategy for Assigning Genetic Code Multiplicity.

Author: Gardini S, Cheli S, Baroni S, Di Lascio G, Mangiavacchi G, Micheletti N, Monaco CL, Savini L, Alocci D, Mangani S, and Niccolai N
Subjects: Codon genetics, Databases, Protein, Humans, Models, Molecular, Nucleic Acid Conformation, Protein Conformation, Proteins chemistry, Proteins genetics, Computational Biology, Genetic Code genetics
Abstract: Genetic code redundancy would yield, on the average, the assignment of three codons for each of the natural amino acids. The fact that this number is observed only for incorporating Ile and to stop RNA translation still waits for an overall explanation. Through a Structural Bioinformatics approach, the wealth of information stored in the Protein Data Bank has been used here to look for unambiguous clues to decipher the rationale of standard genetic code (SGC) in assigning from one to six different codons for amino acid translation. Leu and Arg, both protected from translational errors by six codons, offer the clearest clue by appearing as the most abundant amino acids in protein-protein and protein-nucleic acid interfaces. Other SGC hidden messages have been sought by analyzing, in a protein structure framework, the roles of over- and under-protected amino acids.
Published: 2016
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31. The etiologic subtype of intracerebral hemorrhage may influence the risk of significant hematoma expansion.

Author: Cappellari M, Zivelonghi C, Moretto G, Micheletti N, Carletti M, Tomelleri G, and Bovi P
Subjects: Aged, Aged, 80 and over, Cerebral Amyloid Angiopathy etiology, Female, Humans, Male, Middle Aged, Retrospective Studies, Tomography Scanners, X-Ray Computed, Cerebral Hemorrhage complications, Hematoma etiology
Abstract: Background: Intracerebral hemorrhage (ICH) growth is an important independent predictor of clinical deterioration and outcome. Little is known about the association between etiology of ICH and occurrence of hematoma expansion (HE). The aim of the present study was to assess whether ICH etiologic subtype may influence the risk of significant HE., Methods: We conducted an analysis on retrospectively collected data of 424 consecutive patients with ICH, who were admitted to the Verona General Hospital, from March 2011 to December 2014. Using the SMASH-U (Structural vascular lesions, Medication, Amyloid angiopathy, Systemic disease, Hypertension, or Undetermined) classification, we identified the ICH etiologic subtypes. Outcome measure was significant HE (an absolute increase in ICH volume>12.5 mL or >50%) within 48 h., Results: Significant HE occurred in 11/57 (19.3%) Amyloid, 7/14 (50%) Structural, 31/57 (54.4%) Medication, 25/44 (56.8%) in Systemic, 62/139 (44.6%) Hypertensive, and 21/68 (30.9%) Undetermined ICH. Baseline ICH volume (OR 1.011 per mL, 95% CI 1.006-1.017, p<0.001) and onset-to-baseline CT time (OR 0.919 per hour, 95% CI 0.852-0.990, p=0.027) were predictors of significant HE. Compared with Amyloid ICH, ORs for significant HE were higher in patients with Structural ICH (OR 1.430, 95% CI 1.060-1.948, p=0.023), Medication ICH (OR 4.344, 95% CI 1.382-13.653, p=0.012), Systemic ICH (OR 1.796, 95% CI 1.070-3.015, p=0.027), and Hypertensive ICH (OR 3.081, 95% CI 1.426-6.655, p=0.004)., Conclusion: Our study shows that Structural, Medication, Systemic, and Hypertensive ICH were the etiologic subtypes associated with a higher risk of significant HE, compared with Amyloid ICH patients., (Copyright © 2015 Elsevier B.V. All rights reserved.)
Published: 2015
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32. Impairment of homonymous processing in Alzheimer's disease.

Author: Piccirilli M, D'Alessandro P, Micheletti N, Macone S, Scarponi L, Arcelli P, Petrillo SM, Silvestrini M, and Luzzi S
Subjects: Aged, Aged, 80 and over, Comprehension physiology, Cues, Female, Humans, Language Disorders diagnosis, Male, Middle Aged, Names, Psychiatric Status Rating Scales, Semantics, Statistics, Nonparametric, Alzheimer Disease complications, Language Disorders etiology, Phonetics
Abstract: An important issue in research on language is how concepts are represented and associated with each other in the brain. Many investigations have focused on language ambiguity and the phenomenon of homonymy in which a single lexical item, presenting the same form, is related to different meanings. Our study aims to test the hypothesis that weak association of meaning characterizing homonyms may be especially prone to brain damage. To verify this hypothesis a test of attribution of the meaning of homonymous words, the Humpty Dumpty (HD) test, was applied to 50 patients with Alzheimer's disease (AD) and 50 healthy subjects. Results show that AD patients are impaired in the HD test in an early phase of disease and that performance correlates with naming ability and phonological fluency. The data are in keeping with a growing body of literature that supports dual impairment to the semantic system in AD, i.e., to semantic knowledge and active processing and access to the semantic field. The evaluation of the ability to resolve homonymous ambiguity, using the HD test, may provide a useful and quick clinical tool to detect the anomalies of the semantic network linked to either a loss of the core system where meaning of words is stored or an impairment of the access to an intact semantic representation.
Published: 2015
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33. Cardioembolic stroke in the THRombolysis and STatins (THRaST) study.

Author: Cappellari M, Bovi P, Toni D, Micheletti N, Tomelleri G, Carletti M, and Moretto G
Subjects: Acute Disease, Clinical Trials as Topic, Humans, Treatment Outcome, Fibrinolytic Agents therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Stroke drug therapy, Thrombolytic Therapy, Tissue Plasminogen Activator therapeutic use
Published: 2015
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34. Yield of ultra-rapid carotid ultrasound and stroke specialist assessment in patients with TIA and minor stroke: an Italian TIA service audit.

Author: Gulli G, Peron E, Ricci G, Formaglio E, Micheletti N, Tomelleri G, and Moretto G
Subjects: Adult, Aged, Aged, 80 and over, Female, Humans, Italy, Male, Middle Aged, Referral and Consultation, Severity of Illness Index, Time Factors, Ultrasonography, Doppler, Duplex, Vertebral Artery, Young Adult, Carotid Arteries diagnostic imaging, Clinical Audit, Ischemic Attack, Transient diagnostic imaging, Stroke diagnostic imaging
Abstract: In Italy the vast majority of TIA and minor strokes are seen in the A&E. Early diagnosis and management of TIA and minor stroke in this setting is habitually difficult and often lead to cost-ineffective hospital admissions. We set up an ultra-rapid TIA service run by neurovascular physicians based on early specialist assessment and ultrasound vascular imaging. We audit the clinical effectiveness and feasibility of the service and the impact of this service on TIA and minor strokes hospital admissions. We compared the rate of TIA and minor stroke admissions/discharges in the year before (T0) and in the year during which the TIA service was operating (T1). At T1 57 patients had specialist evaluation and 51 (89.5 %) of them were discharged home. Two (3.5 %) patients had recurrent symptoms after discharge. Seven had a pathological carotid Doppler ultrasound. Four of them had hospital admission and subsequent carotid endoarterectomy within a week. Taking the whole neurology department into consideration at T1 there was a 30-41 % reduction in discharges of patients with TIA or minor stroke. Taking the stroke unit section into consideration at T1 there was a 25 % reduction in admissions of patients with NIHSS score <4 and 40 % reduction in admissions of patients with Barthel Index above 80. The model of TIA service we implemented based on ultra-rapid stroke physician assessment and carotid ultrasound investigation is feasible and clinically valid. Indirect evidence suggests that it reduced the rate of expensive TIA/minor stroke hospital admissions.
Published: 2014
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35. Off-label thrombolysis versus full adherence to the current European Alteplase license: impact on early clinical outcomes after acute ischemic stroke.

Author: Cappellari M, Moretto G, Micheletti N, Donato F, Tomelleri G, Gulli G, Carletti M, Squintani GM, Zanoni T, Ottaviani S, Romito S, Tommasi G, Musso AM, Deotto L, Gambina G, Zimatore DS, and Bovi P
Subjects: Aged, Aged, 80 and over, Brain Ischemia epidemiology, Female, Fibrinolytic Agents adverse effects, Humans, Male, Middle Aged, Prospective Studies, Stroke epidemiology, Time Factors, Tissue Plasminogen Activator adverse effects, Brain Ischemia drug therapy, Fibrinolytic Agents therapeutic use, Off-Label Use, Stroke drug therapy, Thrombolytic Therapy, Tissue Plasminogen Activator therapeutic use
Abstract: According to current European Alteplase license, therapeutic-window for intravenous (IV) thrombolysis in acute ischemic stroke has recently been extended to 4.5 h after symptoms onset. However, due to numerous contraindications, the portion of patients eligible for treatment still remains limited. Early neurological status after thrombolysis could identify more faithfully the impact of off-label Alteplase use that long-term functional outcome. We aimed to identify the impact of off-label thrombolysis and each off-label criterion on early clinical outcomes compared with the current European Alteplase license. We conducted an analysis on prospectively collected data of 500 consecutive thrombolysed patients. The primary outcome measures included major neurological improvement (NIHSS score decrease of ≤8 points from baseline or NIHSS score of 0) and neurological deterioration (NIHSS score increase of ≥4 points from baseline or death) at 24 h. We estimated the independent effect of off-label thrombolysis and each off-label criterion by calculating the odds ratio (OR) with 2-sided 95% confidence interval (CI) for each outcome measure. As the reference, we used patients fully adhering to the current European Alteplase license. 237 (47.4%) patients were treated with IV thrombolysis beyond the current European Alteplase license. We did not find significant differences between off- and on-label thrombolysis on early clinical outcomes. No off-label criteria were associated with decreased rate of major neurological improvement compared with on-label thrombolysis. History of stroke and concomitant diabetes was the only off-label criterion associated with increased rate of neurological deterioration (OR 5.84, 95% CI 1.61-21.19; p = 0.024). Off-label thrombolysis may be less effective at 24 h than on-label Alteplase use in patients with previous stroke and concomitant diabetes. Instead, the impact of other off-label criteria on early clinical outcomes was not different compared with current European Alteplase license.
Published: 2014
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36. The risk stratification based on the CHA₂DS₂-VASc may predict the response to intravenous thrombolysis after stroke.

Author: Cappellari M, Bovi P, Micheletti N, Tomelleri G, and Moretto G
Subjects: Administration, Intravenous, Aged, Cohort Studies, Female, Humans, Male, Multivariate Analysis, Outcome Assessment, Health Care, ROC Curve, Atrial Fibrillation complications, Atrial Fibrillation drug therapy, Fibrinolytic Agents administration & dosage, Severity of Illness Index, Stroke complications, Stroke drug therapy
Abstract: CHA2DS2-VASc score influences the outcome in stroke patients with or without atrial fibrillation (AF). We assessed whether the risk stratification based on the prestroke CHA2DS2-VASc score may predict the response to intravenous (IV) thrombolysis in stroke patients. We conducted an analysis on prospectively collected data of 516 consecutive AF and non-AF patients treated with IV thrombolysis. Outcome measures were major improvement (NIH Stroke Scale [NIHSS] ≤8 points from baseline or NIHSS score 0) and deterioration (death or NIHSS ≥1 points from baseline) or no improvement (NIHSS score equivalent to baseline) at 24 h; excellent (modified Rankin Scale [mRS] score ≤1) and unfavorable outcome (mRS score >2) at 3 months. Multivariate analysis showed that ORs for major improvement and excellent outcome were lower in patients with intermediate risk (CHA2DS2-VASc = 1) (OR 0.39, 95 % CI 0.16-0.92, p = 0.032; OR 0.10, 95 % CI 0.02-0.56, p = 0.009), moderately high risk (CHA2DS2-VASc = 2) (OR 0.43, 95 % CI 0.19-0.96, p = 0.040; OR 0.16, 95 % CI 0.03-0.76, p = 0.022), and very high risk (CHA2DS2-VASc > 3) (OR 0.31, 95 % CI 0.15-0.65, p = 0.002; OR 0.17, 95 % CI 0.04-0.81, p = 0.026), whereas ORs for deterioration or no improvement and unfavorable outcome were higher only in patients with very high risk (OR 4.26, 95 % CI 1.24-14.65, p = 0.021; OR 9.26, 95 % CI 1.15-74.65, p = 0.037), compared with low risk (CHA2DS2-VASc = 0). Low-risk level based on the prestroke CHA2DS2-VASc score was predictor of effective response to IV thrombolysis. Very high-risk level was predictor of failed response, compared with low-risk level.
Published: 2013
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37. Intravenous alteplase for acute ischemic stroke in patients with current malignant neoplasm.

Author: Cappellari M, Carletti M, Micheletti N, Tomelleri G, Ajena D, Moretto G, and Bovi P
Subjects: Aged, Aged, 80 and over, Brain Ischemia epidemiology, Cerebral Hemorrhage chemically induced, Cerebral Hemorrhage epidemiology, Female, Fibrinolytic Agents adverse effects, Humans, Infusions, Intravenous, Male, Middle Aged, Neoplasms epidemiology, Retrospective Studies, Stroke epidemiology, Tissue Plasminogen Activator adverse effects, Treatment Outcome, Brain Ischemia drug therapy, Fibrinolytic Agents administration & dosage, Neoplasms drug therapy, Stroke drug therapy, Tissue Plasminogen Activator administration & dosage, Tissue Plasminogen Activator physiology
Abstract: Background: The current European license for Alteplase in acute ischemic stroke excludes the patients who have neoplasm with increased bleeding, but this criterion is not clearly defined. The aim of the present study is to assess whether intravenous (IV) thrombolysis is safe and effective in patients with current non-malignant neoplasm in absence of metastatic disease or other additional risk factors of bleeding., Methods: We reviewed the clinical characteristics of 11 thrombolysed patients with current malignant neoplasm. We decided to treat only patients who did not have one or more of the following additional risk factors of bleeding: metastatic malignant disease; recent bleeding; documented hemorrhagic diathesis, also including baseline normal platelet count, activated partial thromboplastin time and prothrombin time value; and anticoagulant treatment on admission., Results: Cancer was diagnosed before IV thrombolysis in 9 patients, while non-metastatic malignant disease was incidentally detected after IV thrombolysis in 2 patients. None of the patients showed severe hemorrhagic complications. At 7days, all patients that showed a reduction of 4 points or more in the National Institutes of Health Stroke Scale from baseline were asymptomatic. At 3months, functional outcome was favorable in 7 (73%) patients., Conclusions: Our experience suggests that IV thrombolysis does not appear to increase the risk of hemorrhagic complications in current non-metastatic cancer patients in absence of additional risk factors of bleeding. In addition, these patients showed clinical improvement after IV thrombolysis, although replication of our findings in a randomized controlled trial is required to confirm our results., (Copyright © 2012 Elsevier B.V. All rights reserved.)
Published: 2013
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