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3. Divergence Between Clinical Trial Evidence and Actual Practice in Use of Dual Antiplatelet Therapy After Transient Ischemic Attack and Minor Stroke

Author

De Matteis, E, De Santis, F, Ornello, R, Censori, B, Puglisi, V, Vinciguerra, L, Giossi, A, Di Viesti, P, Inchingolo, V, Fratta, G, Diomedi, M, Bagnato, M, Cenciarelli, S, Bedetti, C, Padiglioni, C, Tassinari, T, Saia, V, Russo, A, Petruzzellis, M, Mezzapesa, D, Caccamo, M, Rinaldi, G, Bavaro, A, Paciaroni, M, Mosconi, M, Foschi, M, Querzani, P, Muscia, F, Gallo Cassarino, S, Candelaresi, P, De Mase, A, Guarino, M, Cupini, L, Sanzaro, E, Zini, A, La Spada, S, Palmieri, C, Sepe, F, Beretta, S, Paci, C, Caggia, E, De Angelis, M, Bonanni, L, Volpi, G, Tassi, R, Pistoia, F, Scoditti, U, Tonon, A, Viticchi, G, Ruzza, G, Nencini, P, Cavallini, A, Toni, D, Ricci, S, Sacco, S, De Matteis E., De Santis F., Ornello R., Censori B., Puglisi V., Vinciguerra L., Giossi A., Di Viesti P., Inchingolo V., Fratta G. M., Diomedi M., Bagnato M. R., Cenciarelli S., Bedetti C., Padiglioni C., Tassinari T., Saia V., Russo A., Petruzzellis M., Mezzapesa D. M., Caccamo M., Rinaldi G., Bavaro A., Paciaroni M., Mosconi M. G., Foschi M., Querzani P., Muscia F., Gallo Cassarino S., Candelaresi P., De Mase A., Guarino M., Cupini L. M., Sanzaro E., Zini A., La Spada S., Palmieri C., Sepe F. N., Beretta S., Paci C., Caggia E. A., De Angelis M. V., Bonanni L., Volpi G., Tassi R., Pistoia F., Scoditti U., Tonon A., Viticchi G., Ruzza G., Nencini P., Cavallini A., Toni D., Ricci S., Sacco S., De Matteis, E, De Santis, F, Ornello, R, Censori, B, Puglisi, V, Vinciguerra, L, Giossi, A, Di Viesti, P, Inchingolo, V, Fratta, G, Diomedi, M, Bagnato, M, Cenciarelli, S, Bedetti, C, Padiglioni, C, Tassinari, T, Saia, V, Russo, A, Petruzzellis, M, Mezzapesa, D, Caccamo, M, Rinaldi, G, Bavaro, A, Paciaroni, M, Mosconi, M, Foschi, M, Querzani, P, Muscia, F, Gallo Cassarino, S, Candelaresi, P, De Mase, A, Guarino, M, Cupini, L, Sanzaro, E, Zini, A, La Spada, S, Palmieri, C, Sepe, F, Beretta, S, Paci, C, Caggia, E, De Angelis, M, Bonanni, L, Volpi, G, Tassi, R, Pistoia, F, Scoditti, U, Tonon, A, Viticchi, G, Ruzza, G, Nencini, P, Cavallini, A, Toni, D, Ricci, S, Sacco, S, De Matteis E., De Santis F., Ornello R., Censori B., Puglisi V., Vinciguerra L., Giossi A., Di Viesti P., Inchingolo V., Fratta G. M., Diomedi M., Bagnato M. R., Cenciarelli S., Bedetti C., Padiglioni C., Tassinari T., Saia V., Russo A., Petruzzellis M., Mezzapesa D. M., Caccamo M., Rinaldi G., Bavaro A., Paciaroni M., Mosconi M. G., Foschi M., Querzani P., Muscia F., Gallo Cassarino S., Candelaresi P., De Mase A., Guarino M., Cupini L. M., Sanzaro E., Zini A., La Spada S., Palmieri C., Sepe F. N., Beretta S., Paci C., Caggia E. A., De Angelis M. V., Bonanni L., Volpi G., Tassi R., Pistoia F., Scoditti U., Tonon A., Viticchi G., Ruzza G., Nencini P., Cavallini A., Toni D., Ricci S., and Sacco S.

Published
2023

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., 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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5. Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

Author

Pieralli, F., Vannucchi, V., Nozzoli, C., Augello, G., Dentali, F., De Marzi, G., Uomo, G., Risaliti, F., Morbidoni, L., Mazzone, A., Santini, C., Tirotta, D., Corradi, F., Gerloni, R., Gnerre, P., Gussoni, G., Valerio, A., Campanini, M., Manfellotto, D., Fontanella, A., Attardo, T., Tavecchia, L., Gessi, V., Torrigiani, A., Corbo, L., Gallucci, F., Mastrobuoni, C., Giani, A., Teodora, C., Ricchiuti, E., Rosato, A., Giampaolo, L., Di Gregorio, S., Parodi, L., Pallini, F., Landini, G., Giuri, P., Prampolini, G., Arioli, D., Leone, M. C., Canale, C., Condemi, F., Lupica, R., Manzola, F., Masciana, R., Agnelli, G., Becattini, C., D'Agostini, E., Mosconi, M. G., Bogliari, G., Rossi, A., Iannantuoni, G., Bartolino, L., Montagnani, A., Verdiani, V., Gambacorta, M., Lenti, S., Francioni, S., Pierfranceschi, M. G., Cattabiani, C., Orlandini, F., Scuotri, L., La Regina, M., Corsini, F., Anastasio, L., Mumoli, N., Mazzi, V., Camaiti, A., Balbi, G., Ragazzo, F., Pengo, M., Pieralli, F, Vannucchi, V, Nozzoli, C, Augello, G, Dentali, F, De Marzi, G, Uomo, G, Risaliti, F, Morbidoni, L, Mazzone, A, Santini, C, Tirotta, D, Corradi, F, Gerloni, R, Gnerre, P, Gussoni, G, Valerio, A, Campanini, M, Manfellotto, D, Fontanella, A, Attardo, T, Tavecchia, L, Gessi, V, Torrigiani, A, Corbo, L, Gallucci, F, Mastrobuoni, C, Giani, A, Teodora, C, Ricchiuti, E, Rosato, A, Giampaolo, L, Di Gregorio, S, Parodi, L, Pallini, F, Landini, G, Giuri, P, Prampolini, G, Arioli, D, Leone, M, Canale, C, Condemi, F, Lupica, R, Manzola, F, Masciana, R, Agnelli, G, Becattini, C, D'Agostini, E, Mosconi, M, Bogliari, G, Rossi, A, Iannantuoni, G, Bartolino, L, Montagnani, A, Verdiani, V, Gambacorta, M, Lenti, S, Francioni, S, Pierfranceschi, M, Cattabiani, C, Orlandini, F, Scuotri, L, La Regina, M, Corsini, F, Anastasio, L, Mumoli, N, Mazzi, V, Camaiti, A, Balbi, G, Ragazzo, F, and Pengo, M

Subjects
Male, medicine.medical_specialty, Acute coronary syndrome, Community-acquired pneumonia, Myocardial Infarction, Disease, Cardiovascular event, 030204 cardiovascular system & hematology, lcsh:Infectious and parasitic diseases, Cardiovascular events, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, medicine, Prevalence, Pneumonia, Bacterial, 80 and over, Humans, Cumulative incidence, lcsh:RC109-216, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Aged, Aged, 80 and over, business.industry, Incidence, Bacterial, Correction, Pneumonia, Length of Stay, Middle Aged, medicine.disease, Hospitalization, Community-Acquired Infections, Infectious Diseases, Italy, Heart failure, Observational study, Female, business, Hospital Units, Research Article
Abstract

Background The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). Methods This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. Results A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p p = 0.009). Conclusion Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. Trial registration NCT03798457 Registered 10 January 2019 - Retrospectively registered

Published
2021

6. Acute cardiovascular events in patients with community acquired pneumonia: results from the observational prospective FADOI-ICECAP study

Author

Pieralli, F, Vannucchi, V, Nozzoli, C, Augello, G, Dentali, F, De Marzi, G, Uomo, G, Risaliti, F, Morbidoni, L, Mazzone, A, Santini, C, Tirotta, D, Corradi, F, Gerloni, R, Gnerre, P, Gussoni, G, Valerio, A, Campanini, M, Manfellotto, D, Fontanella, A, Attardo, T, Tavecchia, L, Gessi, V, Torrigiani, A, Corbo, L, Gallucci, F, Mastrobuoni, C, Giani, A, Teodora, C, Ricchiuti, E, Rosato, A, Giampaolo, L, Di Gregorio, S, Parodi, L, Pallini, F, Landini, G, Giuri, P, Prampolini, G, Arioli, D, Leone, M, Canale, C, Condemi, F, Lupica, R, Manzola, F, Masciana, R, Agnelli, G, Becattini, C, D'Agostini, E, Mosconi, M, Bogliari, G, Rossi, A, Iannantuoni, G, Bartolino, L, Montagnani, A, Verdiani, V, Gambacorta, M, Lenti, S, Francioni, S, Pierfranceschi, M, Cattabiani, C, Orlandini, F, Scuotri, L, La Regina, M, Corsini, F, Anastasio, L, Mumoli, N, Mazzi, V, Camaiti, A, Balbi, G, Ragazzo, F, Pengo, M, Pieralli F., Vannucchi V., Nozzoli C., Augello G., Dentali F., De Marzi G., Uomo G., Risaliti F., Morbidoni L., Mazzone A., Santini C., Tirotta D., Corradi F., Gerloni R., Gnerre P., Gussoni G., Valerio A., Campanini M., Manfellotto D., Fontanella A., Attardo T., Tavecchia L., Gessi V., Torrigiani A., Corbo L., Gallucci F., Mastrobuoni C., Giani A., Teodora C., Ricchiuti E., Rosato A., Giampaolo L., Di Gregorio S., Parodi L., Pallini F., Landini G., Giuri P., Prampolini G., Arioli D., Leone M. C., Canale C., Condemi F., Lupica R., Manzola F., Masciana R., Agnelli G., Becattini C., D'Agostini E., Mosconi M. G., Bogliari G., Rossi A., Iannantuoni G., Bartolino L., Montagnani A., Verdiani V., Gambacorta M., Lenti S., Francioni S., Pierfranceschi M. G., Cattabiani C., Orlandini F., Scuotri L., La Regina M., Corsini F., Anastasio L., Mumoli N., Mazzi V., Camaiti A., Balbi G., Ragazzo F., Pengo M., Pieralli, F, Vannucchi, V, Nozzoli, C, Augello, G, Dentali, F, De Marzi, G, Uomo, G, Risaliti, F, Morbidoni, L, Mazzone, A, Santini, C, Tirotta, D, Corradi, F, Gerloni, R, Gnerre, P, Gussoni, G, Valerio, A, Campanini, M, Manfellotto, D, Fontanella, A, Attardo, T, Tavecchia, L, Gessi, V, Torrigiani, A, Corbo, L, Gallucci, F, Mastrobuoni, C, Giani, A, Teodora, C, Ricchiuti, E, Rosato, A, Giampaolo, L, Di Gregorio, S, Parodi, L, Pallini, F, Landini, G, Giuri, P, Prampolini, G, Arioli, D, Leone, M, Canale, C, Condemi, F, Lupica, R, Manzola, F, Masciana, R, Agnelli, G, Becattini, C, D'Agostini, E, Mosconi, M, Bogliari, G, Rossi, A, Iannantuoni, G, Bartolino, L, Montagnani, A, Verdiani, V, Gambacorta, M, Lenti, S, Francioni, S, Pierfranceschi, M, Cattabiani, C, Orlandini, F, Scuotri, L, La Regina, M, Corsini, F, Anastasio, L, Mumoli, N, Mazzi, V, Camaiti, A, Balbi, G, Ragazzo, F, Pengo, M, Pieralli F., Vannucchi V., Nozzoli C., Augello G., Dentali F., De Marzi G., Uomo G., Risaliti F., Morbidoni L., Mazzone A., Santini C., Tirotta D., Corradi F., Gerloni R., Gnerre P., Gussoni G., Valerio A., Campanini M., Manfellotto D., Fontanella A., Attardo T., Tavecchia L., Gessi V., Torrigiani A., Corbo L., Gallucci F., Mastrobuoni C., Giani A., Teodora C., Ricchiuti E., Rosato A., Giampaolo L., Di Gregorio S., Parodi L., Pallini F., Landini G., Giuri P., Prampolini G., Arioli D., Leone M. C., Canale C., Condemi F., Lupica R., Manzola F., Masciana R., Agnelli G., Becattini C., D'Agostini E., Mosconi M. G., Bogliari G., Rossi A., Iannantuoni G., Bartolino L., Montagnani A., Verdiani V., Gambacorta M., Lenti S., Francioni S., Pierfranceschi M. G., Cattabiani C., Orlandini F., Scuotri L., La Regina M., Corsini F., Anastasio L., Mumoli N., Mazzi V., Camaiti A., Balbi G., Ragazzo F., and Pengo M.

Abstract

Background: The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). Methods: This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. Results: A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14–2.51; p = 0.009). Conclusion: Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. Trial registration: NCT03798457 Registered 10 January 2019 - Retrospectively registered

Published
2021

7. Reperfusion strategies in stroke due to isolated cervical internal carotid artery occlusion: systematic review and treatment comparison

Author

Romoli, M., Mosconi, M. G., Pierini, P., Alberti, A., Venti, M., Caso, V., Vidale, S., Lotti, E. M., Longoni, M., Calabresi, P., Tsivgoulis, G., Paciaroni, M., Calabresi P. (ORCID:0000-0003-0326-5509), Romoli, M., Mosconi, M. G., Pierini, P., Alberti, A., Venti, M., Caso, V., Vidale, S., Lotti, E. M., Longoni, M., Calabresi, P., Tsivgoulis, G., Paciaroni, M., and Calabresi P. (ORCID:0000-0003-0326-5509)

Abstract

Introduction: Despite intravenous thrombolysis (IVT) and endovascular treatment (EVT) have been demonstrated effective in acute ischemic stroke (AIS) due to large vessel occlusions, there are still no conclusive data to guide treatment in stroke due to cervical internal carotid artery (ICA) occlusion. We systematically reviewed available literature to compare IVT, EVT, and bridging (IVT + EVT) and define optimal treatment. Methods: Systematic review followed predefined protocol (Open-Science-Framework osf.io/bfykj). MEDLINE, EMBASE, and Cochrane CENTRAL were searched. Results were restricted to studies in English, with sample size ≥ 10 and follow-up ≥30 days. Primary outcomes were favorable outcome (mRS ≤ 2), mortality, and symptomatic intracerebral hemorrhage(sICH), defined according to study original report. Newcastle-Ottawa scale was used for bias assessment. Results: Seven records of 930 screened were included in meta-analysis. Quality of studies was low-to-fair in 5, good in 2. IVT (n = 450) did not differ for favorable outcome and mortality compared to EVT (n = 150), though having lower rate of sICH (OR = 0.4, 95% CI 0.2–0.8). Compared to IVT, bridging (IVT + EVT) was associated with higher rate of favorable outcome (OR = 2.2, 95% CI 1.3–3.7). Compared to EVT, bridging (IVT + EVT) provided higher rate of favorable outcome (OR = 1.9, 95% CI 1.1–3.4), with a marginally increased risk of sICH (OR = 2.1, 95% CI 1–4.4) but similar mortality rates. Conclusions: Our systematic review highlights that, in acute ischemic stroke associated with isolated cervical ICA occlusion, bridging (IVT + EVT) might lead to higher rate of functional independence at follow-up, without increasing mortality. The low quality of available studies prevents from drawing firm conclusions, and randomized-controlled clinical trials are critically needed to define optimal treatment in this AIS subgroup.

Published
2020

9. Time trends, frequency, characteristics and prognosis of short‐duration transient global amnesia

Author

Romoli, M., primary, Tuna, M. A., additional, Li, L., additional, Paciaroni, M., additional, Giannandrea, D., additional, Tordo Caprioli, F., additional, Lotti, A., additional, Eusebi, P., additional, Mosconi, M. G., additional, Pellizzaro Venti, M., additional, Salvadori, N., additional, Gili, A., additional, Ricci, S., additional, Stracci, F., additional, Sarchielli, P., additional, Parnetti, L., additional, Rothwell, P. M., additional, and Calabresi, P., additional

Published
2020
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10. Long-Term Risk of Stroke after Transient Global Amnesia in Two Prospective Cohorts

Author

Romoli, M., Tuna, M. A., Mcgurgan, I., Li, L., Giannandrea, D., Eusebi, P., Caprioli, F. T., Lotti, A., Salvadori, N., Sarchielli, P., Gili, A., Mosconi, M. G., Venti, M. P., Stracci, F., Ricci, S., Paciaroni, M., Parnetti, L., Calabresi, Paolo, Rothwell, P. M., Calabresi P. (ORCID:0000-0003-0326-5509), Romoli, M., Tuna, M. A., Mcgurgan, I., Li, L., Giannandrea, D., Eusebi, P., Caprioli, F. T., Lotti, A., Salvadori, N., Sarchielli, P., Gili, A., Mosconi, M. G., Venti, M. P., Stracci, F., Ricci, S., Paciaroni, M., Parnetti, L., Calabresi, Paolo, Rothwell, P. M., and Calabresi P. (ORCID:0000-0003-0326-5509)

Abstract

Background and Purpose - Transient global amnesia (TGA) is known as a benign syndrome, but recent data from neuroradiological studies support an ischemic cause in some cases, which might suggest an increased susceptibility to cerebrovascular events. We determined the long-term risk of stroke after a first TGA in 2 independent prospective cohorts. Methods - In 2 independent prospective cohorts of patients with TGA (OXVASC [Oxford Vascular Study], population-based; NU (Northern Umbria) cohort, TGA registry), cardiovascular risk factors and long-term outcomes, including stroke and major cardiovascular events, were identified on follow-up. Cardiovascular risk factors were treated according to primary prevention guidelines. In OXVASC, the age-/sex-adjusted risk of stroke during follow-up was compared with that expected from the rate in the underlying study population. Results - Among 525 patients with TGA (425 NU and 100 OXVASC), mean (SD) age was 65.1 (9.5) years and 42.5% male. Hypertension (58.1%), dyslipidemia (40.4%), and smoking (36.4%) were the most frequent cardiovascular risk factors. The risk of stroke was similar in the 2 cohorts, with a pooled annual risk of 0.6% (95% CI, 0.4-0.9) and a 5-year cumulative risk of 2.7% (1.1-4.3). Moreover, the stroke risk in OXVASC cases was no greater than that expected in the underlying study population (adjusted relative risk=0.73; 0.12-4.54; P=0.74). Conclusions - TGA does not carry an increased risk of stroke, at least when cardiovascular risk factors are treated according to primary prevention guidelines.

Published
2019

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