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1. Statin Therapy in Ischemic Stroke Patients with Atrial Fibrillation: Efficacy and Safety Outcomes

Author

Marvardi, Michele, primary, Ferrante, Mario, additional, Paciaroni, Maurizio, additional, Abdul-Rahim, Azmil H, additional, Tsivgoulis, Georgios, additional, Seiffge, David J, additional, Engelter, Stefan T, additional, Lyrer, Philippe A., additional, Polymeris, Alexandros A, additional, Dittrich, Tolga D, additional, Cancelloni, Virginia, additional, Zietz, Annaelle, additional, De Marchis, Gian Marco, additional, Putaala, Jukka, additional, Strbian, Daniel, additional, Tomppo, Liisa, additional, Michel, Patrik, additional, Strambo, Davide, additional, Salerno, Alexander, additional, Vanacker, Peter, additional, Zuurbier, Susanna M., additional, Yperzeele, Laetitia, additional, Loos, Caroline MJ, additional, Cappellari, Manuel, additional, Emiliani, Andrea, additional, Zedde, Marialuisa, additional, Becattini, Cecilia, additional, Pascarella, Rosario, additional, Dawson, Jesse, additional, Cronshaw, Robert, additional, Schirinzi, Erika, additional, Del Sette, Massimo, additional, Stretz, Christoph, additional, Kala, Narendra Sharma, additional, Schomer, Ashley, additional, Mac Grory, Brian, additional, Jayaraman, Mahesh V, additional, Yaghi, Shadi, additional, Furie, Karen L., additional, Masotti, Luca, additional, Grifoni, Elisa, additional, Toni, Danilo, additional, Risitano, Angela, additional, Falcou, Anne A, additional, Petraglia, Luca, additional, Lotti, Enrico Maria, additional, Pavolucci, Lucia, additional, Lochner, Piergiorgio, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Alberti, Andrea, additional, Venti, Michele, additional, Leone De Magistris, Ilaria, additional, Mosconi, Maria Giulia, additional, Giustozzi, Michela, additional, Kargiotis, Odysseas, additional, Rocco, Alessandro, additional, Diomedi, Marina, additional, Marcheselli, Simona, additional, Antonenko, Kateryna, additional, Rota, Eugenia, additional, Tassinari, Tiziana, additional, Saia, Valentina, additional, Palmerini, Francesco, additional, Aridon, Paolo, additional, Arnao, Valentina, additional, Monaco, Serena, additional, Cottone, Salvatore, additional, Baldi, Antonio, additional, D'Amore, Cataldo, additional, Ageno, Walter, additional, Pegoraro, Samuela, additional, Ntaios, George, additional, Adamou, Anastasia, additional, Sagris, Dimitrios, additional, Giannopoulos, Sotirios, additional, Kosmidou, Maria, additional, Ntais, Evangelos, additional, Romoli, Michele, additional, Pantoni, Leonardo, additional, Rosa, Silvia, additional, Bertora, Pierluigi, additional, Chiti, Alberto, additional, Canavero, Isabella, additional, Saggese, Carlo Emanuele, additional, Plocco, Maurizio, additional, Giorli, Elisa, additional, Palaiodimou, Lina, additional, Bakola, Eleni, additional, Bandini, Fabio, additional, Gasparro, Antonio, additional, Terruso, Valeria, additional, Mannino, Marina, additional, Pezzini, Alessandro, additional, Ornello, Raffaele, additional, Sacco, Simona, additional, Popovic, Nemanja, additional, Scoditti, Umberto, additional, Genovese, Antonio, additional, Flomin, Yuriy, additional, Mancuso, Michelangelo, additional, D'agliano, Roberto, additional, Baldini, Marco, additional, Ulivi, Leonardo, additional, Giannini, Nicola, additional, Vadikolias, Konstantinos, additional, Liantinioti, Chrysoula, additional, Chondrogianni, Maria, additional, Halvatsiotis, Panagiotis, additional, Karagkiozi, Efstathia, additional, Athanasakis, George, additional, Makaritsis, Konstantinos, additional, lanari, alessia, additional, Tatlisumak, Turgut, additional, Acciarresi, Monica, additional, Lorenzini, Gianni, additional, Tassi, Rossana, additional, Guideri, Francesca, additional, Acampa, Maurizio, additional, Martini, Giuseppe, additional, Sohn, Sung-Il, additional, Mumoli, Nicola, additional, Cararra, Davide, additional, Maccarrone, Miriam, additional, Galati, Franco, additional, Gourbali, Vanessa, additional, Orlandi, Giovanni, additional, Giuntini, Martina, additional, Corea, Francesco, additional, Bellesini, Marta, additional, Karapanayiotides, Theodore, additional, Csiba, Laszlo, additional, Szabo, Lilla, additional, Imberti, Davide, additional, Pieroni, Alessio, additional, Barlinn, Kristian, additional, Pallesen, Lars-Peder, additional, Barlinn, Jessica, additional, Doronin, Boris, additional, Volodina, Vera Alexandrovna, additional, Agnelli, Giancarlo, additional, Deleu, Dirk, additional, Bonetti, Bruno, additional, Gentile, Luana, additional, Reale, Giuseppe, additional, Caliandro, Pietro, additional, Morotti, Andrea, additional, Vannucchi, Vieri, additional, Padroni, Marina, additional, Letteri, Federica, additional, Magoni, Mauro, additional, Tiseo, Cindy, additional, Rigatelli, Alberto, additional, Zauli, Aurelia, additional, Bossi, Francesco, additional, and Caso, Valeria, additional

Published
2024
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2. Enhancing stroke risk prediction in patients with transient ischemic attack: insights from a prospective cohort study implementing fast-track care.

Author

Barone, Valentina, Foschi, Matteo, Pavolucci, Lucia, Rondelli, Francesca, Rinaldi, Rita, Nicodemo, Marianna, D’Angelo, Roberto, Favaretto, Elisabetta, Brusi, Carlotta, Cosmi, Benilde, Esposti, Daniela Degli, D’Addato, Sergio, Bacchelli, Stefano, Giostra, Fabrizio, Pomata, Daniela Paola, Spinardi, Luca, Faccioli, Luca, Faggioli, Gianluca, Donti, Andrea, and Borghi, Claudio

Subjects
TRANSIENT ischemic attack, STROKE, STROKE units, LONGITUDINAL method, POISSON regression, COHORT analysis
Abstract

Background and aims: Fast-track care have been proved to reduce the shortterm risk of stroke after transient ischemic attack (TIA). We aimed to investigate stroke risk and to characterize short- and long-term stroke predictors in a large cohort of TIA patients undergoing fast-track management. Methods: Prospective study, enrolling consecutive TIA patients admitted to a Northern Italy emergency department from August 2010 to December 2017. All patients underwent fast-track care within 24  h of admission. The primary outcome was defined as the first stroke recurrence at 90  days, 12 and 60  months after TIA. Stroke incidence with 95% confidence interval (CI) at each timepoint was calculated using Poisson regression. Predictors of stroke recurrence were evaluated with Cox regression analysis. The number needed to treat (NNT) of fast-track care in preventing 90-day stroke recurrence in respect to the estimates based on baseline ABCD2 score was also calculated. Results: We enrolled 1,035 patients (54.2% males). Stroke incidence was low throughout the follow-up with rates of 2.2% [95% CI 1.4–3.3%] at 90 days, 2.9% [95% CI 1.9–4.2%] at 12 months and 7.1% [95% CI 5.4–9.0%] at 60 months. Multiple TIA, speech disturbances and presence of ischemic lesion at neuroimaging predicted stroke recurrence at each timepoint. Male sex and increasing age predicted 90-day and 60-month stroke risk, respectively. Hypertension was associated with higher 12-month and 60-month stroke risk. No specific TIA etiology predicted higher stroke risk throughout the followup. The NNT for fast-track care in preventing 90-day stroke was 14.5 [95% CI 11.3–20.4] in the overall cohort and 6.8 [95% CI 4.6–13.5] in patients with baseline ABCD2 of 6 to 7. Conclusion: Our findings support the effectiveness of fast-track care in preventing both short- and long-term stroke recurrence after TIA. Particular effort should be made to identify and monitor patients with baseline predictors of higher stroke risk, which may vary according to follow-up duration. [ABSTRACT FROM AUTHOR]

Published
2024
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4. Capsular Warning Syndrome: Features, Risk Profile, and Prognosis in a Large Prospective TIA Cohort

Author

Foschi, Matteo, Pavolucci, Lucia, Rondelli, Francesca, Barone, Valentina, Rinaldi, Rita, Spinardi, Luca, Favaretto, Elisabetta, Rucci, Paola, Giostra, Fabrizio, Cosmi, Benilde, Borghi, Claudio, Cortelli, Pietro, and Guarino, Maria

Subjects
Stroke, Treatment, Neurology, Capsular warning syndrome, TIA, Neurology (clinical), Prognosis, Cardiology and Cardiovascular Medicine
Abstract

Introduction: Features and prognosis of capsular warning syndrome (CWS) have been poorly investigated prospectively. Aims: The study aimed to characterize CWS clinical features, risk profile, short- and long-term prognosis, among a large TIA cohort. Methods: Prospective cohort study of consecutive TIAs was conducted from August 1, 2010, to December 31, 2017. Demographic and clinical characteristics, risk profile, primary (stroke and composite outcome) and secondary (TIA recurrence, cerebral hemorrhage, new onset atrial fibrillation) outcomes were compared between CWS, lacunar (L), and nonlacunar (NL) TIAs. Results: 1,035 patients (33 CWS, 189 L-TIAs, 813 NL-TIAs) were enrolled. Newly diagnosed (ND) hypertension, hypercholesterolemia, cigarette smoking, and leukoaraiosis were independent risk factors of CWS (p < 0.05). CWS showed the highest stroke (30.3% vs. 0.5% and 1.5% for L-TIAs and NL-TIAs, respectively) and composite outcome risk at follow-up (p < 0.001), but better 3-month post-stroke prognosis (mRS 0–2 90.0% vs. 36.8%; p = 0.002). CWS-related stroke mostly occurred p = 0.010). Intravenous thrombolysis (IVT) showed similar 3-month efficacy and safety in strokes after TIAs groups (median mRS 0, IQR 0–1; p = 0.323). Conclusions: CWS is associated with higher stroke risk and better functional prognosis than L- and NL-TIAs. CWS risk profile is consistent with severe small vessel disease, and ND hypertension could represent a major risk factor. DAPT and IVT seem effective and safe in preventing and treating stroke following CWS.

Published
2022

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

Author

Paciaroni, Maurizio, primary, Caso, Valeria, additional, Agnelli, Giancarlo, additional, Mosconi, Maria Giulia, additional, Giustozzi, Michela, additional, Seiffge, David Julian, additional, Engelter, Stefan T., additional, Lyrer, Philippe, additional, Polymeris, Alexandros A., additional, Kriemler, Lilian, additional, Zietz, Annaelle, additional, Putaala, Jukka, additional, Strbian, Daniel, additional, Tomppo, Liisa, additional, Michel, Patrik, additional, Strambo, Davide, additional, Salerno, Alexander, additional, Remillard, Suzette, additional, Buehrer, Manuela, additional, Bavaud, Odessa, additional, Vanacker, Peter, additional, Zuurbier, Susanna, additional, Yperzeele, Laetitia, additional, Loos, Caroline M.J., additional, Cappellari, Manuel, additional, Emiliani, Andrea, additional, Zedde, Marialuisa, additional, Abdul-Rahim, Azmil, additional, Dawson, Jesse, additional, Cronshaw, Robert, additional, Schirinzi, Erika, additional, Del Sette, Massimo, additional, Stretz, Christoph, additional, Kala, Narendra, additional, Reznik, Michael, additional, Schomer, Ashley, additional, Grory, Brian Mac, additional, Jayaraman, Mahesh, additional, McTaggart, Ryan, additional, Yaghi, Shadi, additional, Furie, Karen L., additional, Masotti, Luca, additional, Grifoni, Elisa, additional, Toni, Danilo, additional, Risitano, Angela, additional, Falcou, Anne, additional, Petraglia, Luca, additional, Lotti, Enrico Maria, additional, Padroni, Marina, additional, Pavolucci, Lucia, additional, Lochner, Piergiorgio, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Alberti, Andrea, additional, Venti, Michele, additional, Traballi, Laura, additional, Urbini, Chiara, additional, Kargiotis, Odysseas, additional, Rocco, Alessandro, additional, Diomedi, Marina, additional, Marcheselli, Simona, additional, Caliandro, Pietro, additional, Zauli, Aurelia, additional, Reale, Giuseppe, additional, Antonenko, Kateryna, additional, Rota, Eugenia, additional, Tassinari, Tiziana, additional, Saia, Valentina, additional, Palmerini, Francesco, additional, Aridon, Paolo, additional, Arnao, Valentina, additional, Monaco, Serena, additional, Cottone, Salvatore, additional, Baldi, Antonio, additional, D’Amore, Cataldo, additional, Ageno, Walter, additional, Pegoraro, Samuela, additional, Ntaios, George, additional, Sagris, Dimitrios, additional, Giannopoulos, Sotirios, additional, Kosmidou, Maria, additional, Ntais, Evangelos, additional, Romoli, Michele, additional, Pantoni, Leonardo, additional, Rosa, Silvia, additional, Bertora, Pierluigi, additional, Chiti, Alberto, additional, Canavero, Isabella, additional, Saggese, Carlo Emanuele, additional, Plocco, Maurizio, additional, Giorli, Elisa, additional, Palaiodimou, Lina, additional, Bakola, Eleni, additional, Tsivgoulis, Georgios, additional, Bandini, Fabio, additional, Gasparro, Antonio, additional, Terruso, Valeria, additional, Mannino, Marina, additional, Pezzini, Alessandro, additional, Ornello, Raffaele, additional, Sacco, Simona, additional, Popovic, Nemanja, additional, Scoditti, Umberto, additional, Genovese, Antonio, additional, Denti, Licia, additional, Flomin, Yuriy, additional, Mancuso, Michelangelo, additional, Ferrari, Elena, additional, Caselli, Maria Chiara, additional, Ulivi, Leonardo, additional, Giannini, Nicola, additional, and De Marchis, Gian Marco, additional

Published
2022
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10. The risk of stroke recurrence in patients with atrial fibrillation and reduced ejection fraction

Author

Paciaroni, Maurizio, Agnelli, Giancarlo, Caso, Valeria, Becattini, Cecilia, Mosconi, Maria Giulia, Giustozzi, Michela, Tsivgoulis, Georgios, Seiffge, David Julian, Engelter, Stefan T., Lyrer, Philippe, Polymeris, Alexandros A., Dittrich, Tolga, Zietz, Annaelle, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna M., Yperzeele, Laetitia, Loos, Caroline M.J., Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil H., Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Mac Grory, Brian, Jayaraman, Mahesh, Yaghi, Shadi, Furie, Karen L., Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Lotti, Enrico Maria, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, De Magistris, Ilaria Leone, Cancelloni, Virginia, Kargiotis, Odysseas, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Moci, Marco, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D’Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrios, Giannopoulos, Sotirios, Kosmidou, Maria, Ntais, Evangelos, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Saggese, Carlo Emanuele, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Morotti, Andrea, Magoni, Mauro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Caselli, Maria Chiara, Ulivi, Leonardo, Giannini, Nicola, Vadikolias, Kostantinos, Liantinioti, Chrysoula, Chondrogianni, Maria, Carletti, Monica, Karagkiozi, Efstathia, Athanasakis, George, Makaritsis, Kostantinos, Lanari, Alessia, Tatlisumak, Turgut, Acciarresi, Monica, Vannucchi, Vieri, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Sohn, Sung-Il, Mumoli, Nicola, Tadi, Prasanna, Letteri, Federica, Maccarrone, Miriam, Galati, Franco, Tiseo, Cindy, Gourbali, Vanessa, Halvatsiotis, Panagiotis, Orlandi, Giovanni, Giuntini, Martina, Corea, Francesco, Bellesini, Marta, Baronello, Mario Maimone, Karapanayiotides, Theodore, Rueckert, Christina, Csiba, Laszló, Szabó, Lilla, Rigatelli, Alberto, Imberti, Davide, Zabzuni, Dorjan, Pieroni, Alessio, Barlinn, Kristian, Pallesen, Lars-Peder, Barlinn, Jessica, Doronin, Boris, Volodina, Vera, Deleu, Dirk, Bonetti, Bruno, Porta, Cesare, Gentile, Luana, Eskandari, Ashraf, and De Marchis, Gian Marco

Abstract

Background: Atrial fibrillation (AF) and congestive heart failure often coexist due to their shared risk factors leading to potential worse outcome, particularly cerebrovascular events. The aims of this study were to calculate the rates of ischemic and severe bleeding events in ischemic stroke patients having both AF and reduced ejection fraction (rEF) (⩽40%), compared to ischemic stroke patients with AF but without rEF.Methods: We performed a retrospective analysis that drew data from prospective studies. The primary outcome was the composite of either ischemic (stroke or systemic embolism), or hemorrhagic events (symptomatic intracranial bleeding and severe extracranial bleeding).Results: The cohort for this analysis comprised 3477 patients with ischemic stroke and AF, of which, 643 (18.3%) had also rEF. After a mean follow-up of 7.5 ± 9.1 months, 375 (10.8%) patients had 382 recorded outcome events, for an annual rate of 18.0%. While the number of primary outcome events in patients with rEF was 86 (13.4%), compared to 289 (10.2%) for the patients without rEF; on multivariable analysis rEF was not associated with the primary outcome (OR 1.25; 95% CI 0.84–1.88). At the end of follow-up, 321 (49.9%) patients with rEF were deceased or disabled (mRS ⩾3), compared with 1145 (40.4%) of those without rEF; on multivariable analysis, rEF was correlated with mortality or disability (OR 1.35; 95% CI 1.03–1.77).Conclusions: In patients with ischemic stroke and AF, the presence of rEF was not associated with the composite outcome of ischemic or hemorrhagic events over short-term follow-up but was associated with increased mortality or disability.

Published
2023
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11. Risk of recurrent stroke in patients with atrial fibrillation treated with oral anticoagulants alone or in combination with anti-platelet therapy

Author

Caliandro, Pietro, Cancelloni, Virginia, Marco, Moci, Reale, Giuseppe, Zauli, Aurelia, Agnelli, Giancarlo, Caso, Valeria, Becattini, Cecilia, Calabresi, Paolo, Giulia Mosconi, Maria, Giustozzi, Michela, Tsivgoulis, Georgios, Julian Seiffge, David, Engelter, Stefan T., Lyrer, Philippe, Polymeris, Alexandros A., Dittrich, Tolga, Zietz, Annaelle, Marco De Marchis, Gian, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna, Yperzeele, Laetitia, Loos, Caroline M.J., Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil, Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Mac Grory, Brian, Jayaraman, Mahesh, McTaggart, Ryan, Yaghi, Shadi, Furie, Karen L., Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Maria Lotti, Enrico, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, Leone De Magistris, Ilaria, Kargiotis, Odysseas, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D’Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrios, Giannopoulos, Sotirios, Kosmidou, Maria, Ntais, Evangelos, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Emanuele Saggese, Carlo, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Chiara Caselli, Maria, Ulivi, Leonardo, Giannini, Nicola, Vadikolias, Kostantinos, Liantinioti, Chrysoula, Chondrogianni, Maria, Halvatsiotis, Panagiotis, Carletti, Monica, Karagkiozi, Efstathia, Athanasakis, George, Makaritsis, Kostantinos, Lanari, Alessia, Tatlisumak, Turgut, Acciarresi, Monica, Vannucchi, Vieri, Lorenzini, Gianni, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Sohn, Sung-Il, Mumoli, Nicola, Tadi, Prasanna, Letteri, Federica, Maccarrone, Miriam, Poli, Loris, Magoni, Mauro, Galati, Franco, Tiseo, Cindy, Gourbali, Vanessa, Orlandi, Giovanni, Giuntini, Martina, Corea, Francesco, Bellesini, Marta, Girardi, Laura, Maimone Baronello, Mario, Karapanayiotides, Theodore, Rueckert, Christina, Csiba, Laszló, Szabó, Lilla, Rigatelli, Alberto, Imberti, Davide, Zabzuni, Dorjan, Pieroni, Alessio, Barlinn, Kristian, Pallesen, Lars-Peder, Barlinn, Jessica, Doronin, Boris, Volodina, Vera, Deleu, Dirk, Bonetti, Bruno, Porta, Cesare, Gentile, Luana, Eskandari, Ashraf, and Paciaroni, Maurizio

Abstract

Introduction: Ischaemic stroke patients with atrial fibrillation (AF) are at high risk of stroke recurrence despite oral anticoagulation therapy. Patients with cardiovascular comorbidities may take both antiplatelet and oral anticoagulation therapy (OAC/AP). Our study aims to evaluate the safety and efficacy of OAC/AP therapy as secondary prevention in people with AF and ischaemic stroke.Patients and methods: We performed a post-hoc analysis of pooled individual data from multicenter prospective cohort studies and compared outcomes in the OAC/AP cohort and patients on DOAC/VKA anticoagulation alone (OAC cohort). Primary outcome was a composite of ischaemic stroke, systemic embolism, intracranial bleeding, and major extracranial bleeding, while secondary outcomes were ischaemic and haemorrhagic events considered separately. A multivariable logistic regression analysis was performed to identify independent predictors for outcome events. To compare the risk of outcome events between the two cohorts, the relation between the survival function and the set of explanatory variables were calculated by Cox proportional hazard models and the results were reported as adjusted hazard ratios (HR). Finally another analysis was performed to compare the overall risk of outcome events in both OAC/AP and OAC cohorts after propensity score matching (PSM).Results: During a mean follow-up time of 7.5 ± 9.1 months (median follow-up time 3.5 months, interquartile range ±3), 2284 stroke patients were on oral anticoagulants and 215 were on combined therapy. The multivariable model demonstrated that the composite outcome is associated with age (OR: 1.03, 95% CI: 1.01–1.04 for each year increase) and concomitant antiplatelet therapy (OR: 2.2, 95% CI: 1.48–3.27), the ischaemic outcome with congestive heart failure (OR: 1.55, 95% CI: 1.02–2.36) and concomitant antiplatelet therapy (OR: 1.93, 95% CI: 1.19–3.13) and the haemorrhagic outcome with age (OR: 1.03, 95% CI: 1.01–1.06 for each year increase), alcoholism (OR: 2.15, 95% CI: 1.06–4.39) and concomitant antiplatelet therapy (OR: 2.22, 95% CI: 1.23–4.02). Cox regression demonstrated a higher rate of the composite outcome (hazard ratio of 1.93 [95% CI, 1.35–2.76]), ischaemic events (HR: 2.05 [95% CI: 1.45–2.87]) and bleeding outcomes (HR: 1.90 [95% CI, 1.06–3.40]) in OAC/AP cohort. After PSM analysis, the composite outcome remained more frequent in people treated with OAC + AP (RR: 1.70 [95% CI, 1.05–2.74]).Discussion: Secondary prevention with combination of oral anticoagulant and antiplatelet therapy after ischaemic stroke was associated with worse outcomes in our cohort.Conclusion: Further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischaemic stroke in patients with atrial fibrillation.

Published
2023
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12. Capsular Warning Syndrome: Features, Risk Profile, and Prognosis in a Large Prospective TIA Cohort.

Author

Foschi, Matteo, Pavolucci, Lucia, Rondelli, Francesca, Barone, Valentina, Rinaldi, Rita, Spinardi, Luca, Favaretto, Elisabetta, Rucci, Paola, Giostra, Fabrizio, Cosmi, Benilde, Borghi, Claudio, Cortelli, Pietro, and Guarino, Maria

Subjects
*LACUNAR stroke, *STROKE, *PROGNOSIS, *CEREBRAL hemorrhage, *PLATELET aggregation inhibitors, *ATRIAL fibrillation
Abstract

Introduction: Features and prognosis of capsular warning syndrome (CWS) have been poorly investigated prospectively. Aims: The study aimed to characterize CWS clinical features, risk profile, short- and long-term prognosis, among a large TIA cohort. Methods: Prospective cohort study of consecutive TIAs was conducted from August 1, 2010, to December 31, 2017. Demographic and clinical characteristics, risk profile, primary (stroke and composite outcome) and secondary (TIA recurrence, cerebral hemorrhage, new onset atrial fibrillation) outcomes were compared between CWS, lacunar (L), and nonlacunar (NL) TIAs. Results: 1,035 patients (33 CWS, 189 L-TIAs, 813 NL-TIAs) were enrolled. Newly diagnosed (ND) hypertension, hypercholesterolemia, cigarette smoking, and leukoaraiosis were independent risk factors of CWS (p < 0.05). CWS showed the highest stroke (30.3% vs. 0.5% and 1.5% for L-TIAs and NL-TIAs, respectively) and composite outcome risk at follow-up (p < 0.001), but better 3-month post-stroke prognosis (mRS 0–2 90.0% vs. 36.8%; p = 0.002). CWS-related stroke mostly occurred <48 h (80.0%) and had a small vessel occlusion etiology (100%), affecting more often the internal capsule (60.0%). Dual antiplatelet therapy (DAPT) versus single antiplatelet therapy was associated with lower 3-month cumulative stroke incidence (12.5% vs. 57.1%; p = 0.010). Intravenous thrombolysis (IVT) showed similar 3-month efficacy and safety in strokes after TIAs groups (median mRS 0, IQR 0–1; p = 0.323). Conclusions: CWS is associated with higher stroke risk and better functional prognosis than L- and NL-TIAs. CWS risk profile is consistent with severe small vessel disease, and ND hypertension could represent a major risk factor. DAPT and IVT seem effective and safe in preventing and treating stroke following CWS. [ABSTRACT FROM AUTHOR]

Published
2023
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13. Clinicoradiological Profile and Functional Outcome of Acute Cerebral Venous Thrombosis: A Hospital-Based Cohort Study

Author

Foschi, Matteo, primary, Pavolucci, Lucia, additional, Rondelli, Francesca, additional, Amore, Giulia, additional, Spinardi, Luca, additional, Rinaldi, Rita, additional, Favaretto, Elisabetta, additional, Favero, Luca, additional, Russo, Michele, additional, Pensato, Umberto, additional, Benini, Matteo, additional, Barone, Valentina, additional, and Guarino, Maria, additional

Published
2021
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14. Introduction to the Italian section for young neurologists

Author

Di Lorenzo, F, Alberti, P, Pavolucci, L, Pietrafusa, N, Iodice, F, Di Lorenzo, Francesco, Alberti, Paola, Pavolucci, Lucia, Pietrafusa, Nicola, Iodice, Francesco, Di Lorenzo, F, Alberti, P, Pavolucci, L, Pietrafusa, N, Iodice, F, Di Lorenzo, Francesco, Alberti, Paola, Pavolucci, Lucia, Pietrafusa, Nicola, and Iodice, Francesco

Published
2019

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

Author

Maurizio Paciaroni, Valeria Caso, Giancarlo Agnelli, Maria Giulia Mosconi, Michela Giustozzi, David Julian Seiffge, Stefan T. Engelter, Philippe Lyrer, Alexandros A. Polymeris, Lilian Kriemler, Annaelle Zietz, Jukka Putaala, Daniel Strbian, Liisa Tomppo, Patrik Michel, Davide Strambo, Alexander Salerno, Suzette Remillard, Manuela Buehrer, Odessa Bavaud, Peter Vanacker, Susanna Zuurbier, Laetitia Yperzeele, Caroline M.J. Loos, Manuel Cappellari, Andrea Emiliani, Marialuisa Zedde, Azmil Abdul-Rahim, Jesse Dawson, Robert Cronshaw, Erika Schirinzi, Massimo Del Sette, Christoph Stretz, Narendra Kala, Michael Reznik, Ashley Schomer, Brian Mac Grory, Mahesh Jayaraman, Ryan McTaggart, Shadi Yaghi, Karen L. Furie, Luca Masotti, Elisa Grifoni, Danilo Toni, Angela Risitano, Anne Falcou, Luca Petraglia, Enrico Maria Lotti, Marina Padroni, Lucia Pavolucci, Piergiorgio Lochner, Giorgio Silvestrelli, Alfonso Ciccone, Andrea Alberti, Michele Venti, Laura Traballi, Chiara Urbini, Odysseas Kargiotis, Alessandro Rocco, Marina Diomedi, Simona Marcheselli, Pietro Caliandro, Aurelia Zauli, Giuseppe Reale, Kateryna Antonenko, Eugenia Rota, Tiziana Tassinari, Valentina Saia, Francesco Palmerini, Paolo Aridon, Valentina Arnao, Serena Monaco, Salvatore Cottone, Antonio Baldi, Cataldo D’Amore, Walter Ageno, Samuela Pegoraro, George Ntaios, Dimitrios Sagris, Sotirios Giannopoulos, Maria Kosmidou, Evangelos Ntais, Michele Romoli, Leonardo Pantoni, Silvia Rosa, Pierluigi Bertora, Alberto Chiti, Isabella Canavero, Carlo Emanuele Saggese, Maurizio Plocco, Elisa Giorli, Lina Palaiodimou, Eleni Bakola, Georgios Tsivgoulis, Fabio Bandini, Antonio Gasparro, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Raffaele Ornello, Simona Sacco, Nemanja Popovic, Umberto Scoditti, Antonio Genovese, Licia Denti, Yuriy Flomin, Michelangelo Mancuso, Elena Ferrari, Maria Chiara Caselli, Leonardo Ulivi, Nicola Giannini, Gian Marco De Marchis, Paciaroni, Maurizio, Caso, Valeria, Agnelli, Giancarlo, Mosconi, Maria Giulia, Giustozzi, Michela, Seiffge, David Julian, Engelter, Stefan T, Lyrer, Philippe, Polymeris, Alexandros A, Kriemler, Lilian, Zietz, Annaelle, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna, Yperzeele, Laetitia, Loos, Caroline M J, Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil, Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Grory, Brian Mac, Jayaraman, Mahesh, McTaggart, Ryan, Yaghi, Shadi, Furie, Karen L, Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Lotti, Enrico Maria, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, Traballi, Laura, Urbini, Chiara, Kargiotis, Odyssea, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D'Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrio, Giannopoulos, Sotirio, Kosmidou, Maria, Ntais, Evangelo, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Saggese, Carlo Emanuele, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Tsivgoulis, Georgio, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Caselli, Maria Chiara, Ulivi, Leonardo, Giannini, Nicola, De Marchis, Gian Marco, and Neurology

Subjects
Oral, Advanced and Specialized Nursing, hypertension, recurrence, anticoagulant, Administration, Oral, Anticoagulants, Hemorrhage, Settore MED/26, Brain Ischemia, Stroke, Risk Factors, Administration, Atrial Fibrillation, Humans, Settore MED/26 - Neurologia, Human medicine, Neurology (clinical), Prospective Studies, Cardiology and Cardiovascular Medicine, atrial fibrillation, ischemic stroke, Ischemic Stroke
Abstract

Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA 2 DS 2 -VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0–1.3] for each point increase; P =0.05) and hypertension (OR, 2.3 [95% CI, 1.0–5.1]; P =0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0–1.2] for each year increase; P =0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4–14.2]; P =0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4–5.5]; P =0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8–1.7]). Conclusions: Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding.

Published
2022

17. Paraneoplastic cerebellar degeneration and lambert-eaton myasthenia in a patient with merkel cell carcinoma and voltage-gated calcium channel antibodies

Author

Maria Pia Foschini, Maria Pia Giannoccaro, Bethan Lang, Angela Vincent, Lucia Pavolucci, Patrizia Avoni, Giulia Giannini, Rocco Liguori, Paolo Tinuper, Pavolucci, Lucia, Giannini, Giulia, Giannoccaro, Maria Pia, Foschini, Maria Pia, Lang, Bethan, Avoni, Patrizia, Tinuper, Paolo, Vincent, Angela, and Liguori, Rocco

Subjects
Male, Pathology, medicine.medical_specialty, Ataxia, Lung Neoplasms, Physiology, Lambert-Eaton myasthenia, Paraneoplastic Cerebellar Degeneration, Lesion, 030207 dermatology & venereal diseases, 03 medical and health sciences, Cellular and Molecular Neuroscience, Merkel cell carcinoma, 0302 clinical medicine, Calcium Channels, N-Type, Physiology (medical), Cerebellar Degeneration, Medicine, Humans, Aged, Autoantibodies, Diplopia, business.industry, Paraneoplastic cerebellar degeneration, medicine.disease, Neuroendocrine neoplasm, Carcinoma, Merkel Cell, Axilla, Lambert-Eaton Myasthenic Syndrome, medicine.anatomical_structure, Cerebellar degeneration, Paraneoplastic syndrome, Neurology (clinical), Small Cell Lung Carcinoma, medicine.symptom, business, 030217 neurology & neurosurgery, Voltage-gated calcium channel antibodie
Abstract

Introduction Merkel cell carcinoma is a rare cutaneous, aggressive tumor. Although it shares many neuroendocrine features with small cell lung carcinoma, it has only occasionally been reported with paraneoplastic neurological syndromes. Methods A healthy 67-year-old man developed acute ataxia, vertigo, and nausea. Subsequently he also developed dysarthria, diplopia, xerostomia, fatigability and progressive anorexia. He underwent a full diagnostic workup and was found to have a high titer of voltage-gated calcium channel antibodies in serum and cerebrospinal fluid, neurophysiological findings compatible with Lambert-Eaton myasthenia and neurological signs compatible with cerebellar degeneration. Results A positron emission tomography study revealed a hypermetabolic lesion in the axilla, subsequently biopsied and consistent with Merkel cell carcinoma. Conclusions In most previous reports, neurological symptoms preceded the Merkel cell carcinoma diagnosis, and the primary localization was in lymph nodes. This tumor should be considered in patients with paraneoplastic syndrome, and particularly Lambert-Eaton myasthenia after exclusion of small cell lung carcinoma. Muscle Nerve 56: 998–1000, 2017

Published
2016

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