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Cappellari M, Pracucci G, Saia V, Sallustio F, Casetta I, Fainardi E, Capasso F, Nencini P, Vallone S, Bigliardi G, Saletti A, De Vito A, Ruggiero M, Longoni M, Semeraro V, Boero G, Silvagni U, Stancati F, Lafe E, Mazzacane F, Bracco S, Tassi R, Comelli S, Melis M, Romano D, Napoletano R, Menozzi R, Scoditti U, Chiumarulo L, Petruzzellis M, Vinci SL, Ferraù L, Taglialatela F, Zini A, Sanna A, Tassinari T, Iacobucci M, Nicolini E, Bergui M, Cerrato P, Giorgianni A, Princiotta Cariddi L, Amistà P, Russo M, Gallesio I, Sepe F, Comai A, Franchini E, Filauri P, Orlandi B, Besana M, Giossi A, Lazzarotti GA, Orlandi G, Castellano D, Naldi A, Plebani M, Zivelonghi C, Invernizzi P, Mangiafico S, Toni D. Predictors for hemorrhagic transformation and cerebral edema in stroke patients with first-pass complete recanalization. Int J Stroke 2023; 18:1238-1246. [PMID: 37337362 DOI: 10.1177/17474930231185690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Predictors of radiological complications attributable to reperfusion injury remain unknown when baseline setting is optimal for endovascular treatment and procedural setting is the best in stroke patients with large vessel occlusion (LVO). AIMS To identify clinical and radiological/procedural predictors for hemorrhagic transformation (HT) and cerebral edema (CED) at 24 hr in patients obtaining complete recanalization in one pass of thrombectomy for ischemic stroke ⩽ 6 h from symptom onset with intra-cranial anterior circulation LVO and ASPECTS ⩾ 6. METHODS We conducted a cohort study on prospectively collected data from 1400 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. RESULTS HT was reported in 248 (18%) patients and early CED was reported in 260 (19.2%) patients. In the logistic regression model including predictors from a first model with clinical variables and from a second model with radiological/procedural variables, diabetes mellitus (odds ratio (OR) = 1.832, 95% confidence interval (CI) = 1.201-2.795), higher National Institutes of Health Stroke Scale (NIHSS) (OR = 1.076, 95% CI = 1.044-1.110), lower Alberta Stroke Program Early CT (ASPECTS) (OR = 0.815, 95% CI = 0.694-0.957), and longer onset-to-groin time (OR = 1.005, 95% CI = 1.002-1.007) were predictors of HT, whereas general anesthesia was inversely associated with HT (OR = 0.540, 95% CI = 0.355-0.820). Higher NIHSS (OR = 1.049, 95% CI = 1.021-1.077), lower ASPECTS (OR = 0.700, 95% CI = 0.613-0.801), intravenous thrombolysis (OR = 1.464, 95% CI = 1.061-2.020), longer onset-to-groin time (OR = 1.002, 95% CI = 1.001-1.005), and longer procedure time (OR = 1.009, 95% CI = 1.004-1.015) were predictors of early CED. After repeating a fourth logistic regression model including also good collaterals, the same variables remained predictors for HT and/or early CED, except diabetes mellitus and thrombolysis, while good collaterals were inversely associated with early CED (OR = 0.385, 95% CI = 0.248-0.599). CONCLUSIONS Higher NIHSS, lower ASPECTS, and longer onset-to-groin time were predictors for both HT and early CED. General anesthesia and good collaterals were inversely associated with HT and early CED, respectively. Longer procedure time was predictor of early CED.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Elvis Lafe
- Policlinico IRCCS San Matteo, Pavia, Italy
| | | | - Sandra Bracco
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | | | | | - Daniele Romano
- AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | | | | | | | | | | | | | | | | | - Andrea Zini
- IRCCS Istituto di Scienze Neurologiche di Bologna, Bologna, Italy
| | | | | | | | | | - Mauro Bergui
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Andrea Giorgianni
- ASST Sette Laghi Varese-Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Monia Russo
- Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Ivan Gallesio
- AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Federica Sepe
- AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | | | | | | | | | | | | | | | | | | | | | - Mauro Plebani
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | | | - Salvatore Mangiafico
- Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
- Tor Vergata University, Rome, Italy
- S. Andrea Hospital, Rome, Italy
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Gentile L, Pracucci G, Saia V, Falcou A, Biraschi F, Zini A, Simonetti L, Riva L, Bigliardi G, Vallone S, Nencini P, Limbucci N, Diomedi M, Da Ros V, Longoni M, Ruggiero M, Tassinari T, Allegretti L, Cerrato P, Rubino E, Bergui M, Cavallo R, Naldi A, Comelli C, Cappellari M, Zivelonghi C, Plebani M, De Vito A, Merli N, Saletti A, Musolino RF, Ferraù L, Vinci SL, Sacco S, Orlandi B, De Santis F, Filauri P, Ruiz L, Sepe FN, Gallesio I, Petruzzellis M, Chiumarulo L, Sangalli D, Salmaggi A, Filizzolo M, Moller J, Melis M, Comelli S, Magoni M, Gilberti N, Gasparotti R, Invernizzi P, Pavia M, Pinto V, Laspada S, Marcheselli S, Ajello D, Viaro F, Baracchini C, Causin F, Giannini N, Caselli MC, Mancuso M, Cosottini M, Scoditti U, Menozzi R, Russo M, Amistá P, Napoletano R, Romano DG, Tassi R, Bracco S, Carimati F, Versino M, Giorgianni A, De Boni A, Fasano A, Barbarini L, Paladini A, Franchini E, Dall'Ora E, Comai A, Giovanni F, Pedicelli A, Sallustio F, Casetta I, Fainardi E, Mangiafico S, Toni D. Mechanical thrombectomy in patients with heart failure: the Italian registry of Endovascular Treatment in Acute Stroke. Neurol Sci 2023; 44:3577-3585. [PMID: 37199875 DOI: 10.1007/s10072-023-06830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Heart failure (HF) is the second most important cardiac risk factor for stroke after atrial fibrillation (AF). Few data are available on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with HF. METHODS The source of data is the multicentre Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). All AIS patients ≥ 18 years receiving MT were categorised in two groups: HF and no-HF. Baseline clinical and neuroradiological findings on admission were analysed. RESULTS Of 8924 patients, 642 (7.2%) had HF. Compared to the no-HF group, HF patients had higher prevalence of cardiovascular risk factors. Rate of complete recanalisation (TICI 2b-3) was 76.9% in HF vs 78.1% in no-HF group (p = 0.481). Rate of symptomatic intracerebral haemorrhage at 24-h non-contrast computed tomography (NCCT) was 7.6% in HF vs 8.3% in no-HF patients (p = 0.520). At 3 months, 36.4% of HF patients and 48.2% of no-HF patients (p < 0.001) had mRS 0-2, and mortality was, respectively, 30.7% and 18.5% (p < 0.001). In multivariate logistic regression, HF was independently associated with mortality at 3 months (OR 1.53, 1.24-1.88 95% CI, p < 0.001). In multivariate ordinal regression, HF patients had a probability of transitioning to a higher mRS level of 1.23 (1.05-1.44 95% CI, p = 0.012). The propensity score analysis of two groups matched for age, sex, and NIHSS at admission yielded the same results. CONCLUSION MT is safe and effective in HF patients with AIS. Patients with HF and AIS suffered from higher 3-month mortality and unfavourable outcome regardless of acute treatments.
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Affiliation(s)
- Luana Gentile
- Department of Neurology and Metropolitan Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Anne Falcou
- Emergency Department, Stroke Unit, Policlinico Umberto I Hospital, Rome, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Andrea Zini
- Department of Neurology and Metropolitan Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Luigi Simonetti
- Neuroradiology Department, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Letizia Riva
- Cardiology Unit, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Stroke Unit, Neurology Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Di Modena, Ospedale Civile Baggiovara, Modena, Italy
| | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile Di Baggiovara, Azienda Ospedaliera Universitaria Di Modena, Modena, Italy
| | - Patrizia Nencini
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Nicola Limbucci
- Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marco Longoni
- Department of Neurology and Stroke Unit Cesena-Forlì, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Maria Ruggiero
- Neuroradiology Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - Tiziana Tassinari
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Luca Allegretti
- Department of Interventional Neuroradiology, Santa Corona Hospital, Pietra Ligure, Italy
| | - Paolo Cerrato
- Stroke Unit, AOU Città Della Salute E Della Scienza, Molinette Hospital, Turin, Italy
| | - Elisa Rubino
- Stroke Unit, AOU Città Della Salute E Della Scienza, Molinette Hospital, Turin, Italy
| | - Mauro Bergui
- Neuroscience Department, University of Torino, Turin, Italy
| | | | - Andrea Naldi
- Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Chiara Comelli
- Interventional Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Manuel Cappellari
- Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cecilia Zivelonghi
- Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Mauro Plebani
- Interventional Neurovascular Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Nicola Merli
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Andrea Saletti
- Department of Radiology, Neuroradiology Unit, Azienda Ospedaliera Universitaria, Arcispedale S. Anna, Ferrara, Italy
| | - Rosa Fortunata Musolino
- Department of Clinical and Experimental Medicine, U.O.S.D. Stroke Unit, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Department of Clinical and Experimental Medicine, U.O.S.D. Stroke Unit, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, Neuroradiology Unit, University of Messina, Messina, Italy
| | - Simona Sacco
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Berardino Orlandi
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Federica De Santis
- Stroke Unit and Neurology Unit, S.S. Filippo and Nicola Hospital, Avezzano, Italy
| | - Pietro Filauri
- Neuroradiology Unit, SS. Filippo and Nicola Hospital, Avezzano, Italy
| | - Luigi Ruiz
- Stroke Unit, SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit, SS. Antonio E Biagio E Cesare Arrigo Hospital, Alessandria, Italy
| | - Marco Petruzzellis
- Neurology Unit and Stroke Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | | | | | | | - Marco Filizzolo
- Interventional Neuroradiology Unit, AOOR Villa Sofia-Cervello, Palermo, Italy
| | | | | | - Simone Comelli
- Vascular and Interventional Neuroradiology Department, ARNAS G. Brotzu, Cagliari, Italy
| | - Mauro Magoni
- Stroke Unit, SpedaliCivili, Vascular Neurology, Brescia, Italy
| | - Nicola Gilberti
- Stroke Unit, SpedaliCivili, Vascular Neurology, Brescia, Italy
| | | | - Paolo Invernizzi
- Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Marco Pavia
- Neuroradiology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Perrino Hospital, Brindisi, Italy
| | | | | | - Daniele Ajello
- Neuroradiology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Federica Viaro
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Francesco Causin
- Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy
| | - Nicola Giannini
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Maria Chiara Caselli
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Department Neurology and Stroke Unit, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technology in Medicine and Surgery, Azienda Ospedaliera Universitaria Di Pisa, Pisa, Italy
| | - Umberto Scoditti
- Stroke Unit, Neurology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Roberto Menozzi
- Neuroradiology Unit, University Hospital of Parma, Parma, Italy
| | - Monia Russo
- Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Pietro Amistá
- Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Rosa Napoletano
- Stroke Unit, S. Giovanni Di Dio E Ruggi d'Aragona Hospital, Salerno, Italy
| | - Daniele Giuseppe Romano
- Unita Operativa Radiologia Vascolare, S. Giovanni Di Dio E Ruggi d'Aragona Hospital, Salerno, Italy
| | - Rossana Tassi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Sandra Bracco
- UO Neurointerventistica, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Federico Carimati
- Department of Neurology and Stroke Unit, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | - Maurizio Versino
- Department of Neurology and Stroke Unit, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | - Andrea Giorgianni
- Neuroradiology Department, Circolo e Fondazione Macchi Hospital, ASST Settelaghi, Varese, Italy
| | | | - Antonio Fasano
- Department of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | | | | | - Enrica Franchini
- Department of Neurology and Stroke Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Elisa Dall'Ora
- Department of Neurology and Stroke Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Alessio Comai
- Neuroradiology Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Frisullo Giovanni
- Department of Neurology and Stroke Unit, Catholic University, Rome, Italy
| | - Alessandro Pedicelli
- Dipartimento Di Diagnostica Per Immagini, UOSA Neuroradiologia Interventistica, RadioterapiaOncologica Ed Ematologia, Fondazione PoliclinicoUniversitarioA.Gemelli Di Roma, Rome, Italy
| | - Fabrizio Sallustio
- Unitá Di Trattamento Neurovascolare, Ospedale Dei Castelli-ASL6, Rome, Italy
| | - Ilaria Casetta
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Enrico Fainardi
- Dipartimento Di Scienze Biomediche, Sperimentali E Cliniche, Università Degli Studi Di Firenze, Ospedale Universitario Careggi, NeuroradiologiaFlorence, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Consultant at IRCCS NeuromedPozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.
- Emergency Department, Stroke Unit, Policlinico Umberto I Hospital, Rome, Italy.
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3
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Cappellari M, Saia V, Pracucci G, Casetta I, Fainardi E, Sallustio F, Ruggiero M, Romoli M, Simonetti L, Zini A, Lazzarotti GA, Orlandi G, Vallone S, Bigliardi G, Renieri L, Nencini P, Semeraro V, Boero G, Bracco S, Tassi R, Castellano D, Naldi A, Biraschi F, Nicolini E, Del Sette B, Malfatto L, Allegretti L, Tassinari T, Tessitore A, Ferraù L, Saletti A, De Vito A, Lafe E, Cavallini A, Bergui M, Bosco G, Feraco P, Bignamini V, Mandruzzato N, Vit F, Mardighian D, Magoni M, Comelli S, Melis M, Menozzi R, Scoditti U, Cester G, Viario F, Stecco A, Fleetwood T, Filauri P, Sacco S, Giorgianni A, Cariddi LP, Piano M, Motto C, Gallesio I, Sepe F, Romano G, Grasso MF, Lozupone E, Fasano A, Comai A, Franchini E, Bruni S, Silvestrini M, Chiumarulo L, Petruzzelli M, Pavia M, Invernizzi P, Puglielli E, Casalena A, Pedicelli A, Frisullo G, Amistà P, Russo M, Allegritti M, Caproni S, Mangiafico S, Toni D. Stroke with large vessel occlusion in the posterior circulation: IV thrombolysis plus thrombectomy versus IV thrombolysis alone. J Thromb Thrombolysis 2023; 56:454-462. [PMID: 37378700 DOI: 10.1007/s11239-023-02844-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
Efficacy and safety of mechanical thrombectomy (MT) for stroke with posterior circulation large vessel occlusion (LVO) is still under debate. We aimed to compare the outcomes of stroke patients with posterior circulation LVO treated with intravenous thrombolysis (IVT) (< 4.5 h after symptom onset) plus MT < 6 h after symptom onset with those treated with IVT alone (< 4.5 h after symptom onset). Patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) and in the Italian centers included in the SITS-ISTR were analysed. We identified 409 IRETAS patients treated with IVT plus MT and 384 SITS-ISTR patients treated with IVT alone. IVT plus MT was significantly associated with higher rate of sICH (ECASS II) compared with IVT alone (3.1 vs 1.9%; OR 3.984, 95% CI 1.014-15.815), while the two treatments did not differ significantly in 3-month mRS score ≤ 3 (64.3 vs 74.1%; OR 0.829, 95% CI 0.524-1.311). In 389 patients with isolated basilar artery (BA) occlusion, IVT plus MT was significantly associated with higher rate of any ICH compared with IVT alone (9.4 vs 7.4%; OR 4.131, 95% CI 1.215-14.040), while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with higher rate mRS score ≤ 2 (69.1 vs 52.1%; OR 2.692, 95% CI 1.064-6.811) and lower rate of death (13.8 vs 27.1%; OR 0.299, 95% CI 0.095-0.942) in patients with distal-segment BA occlusion, while two treatments did not differ significantly in 3-month mRS score ≤ 3 and sICH per ECASS II definition. IVT plus MT was significantly associated with lower rate of mRS score ≤ 3 (37.1 vs 53.3%; OR 0.137, 0.009-0.987), mRS score ≤ 1 (22.9 vs 53.3%; OR 0.066, 95% CI 0.006-0.764), mRS score ≤ 2 (34.3 vs 53.3%; OR 0.102, 95% CI 0.011-0.935), and higher rate of death (51.4 vs 40%; OR 16.244, 1.395-89.209) in patients with proximal-segment BA occlusion. Compared with IVT alone, IVT plus MT was significantly associated with higher rate of sICH per ECASS II definition in patients with stroke and posterior circulation LVO, while two treatment groups did not differ significantly in 3-month mRS score ≤ 3. IVT plus MT was associated with lower rate of mRS score ≤ 3 compared with IVT alone in patients with proximal-segment BA occlusion, whereas no significant difference was found between the two treatments in primary endpoints in patients isolated BA occlusion and in the other subgroups based on site occlusion.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Valentina Saia
- Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Ilaria Casetta
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Enrico Fainardi
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy
| | - Fabrizio Sallustio
- Unitá di Trattamento Neurovascolare, ospedale dei Castelli-ASL6, Roma, Italy
| | - Maria Ruggiero
- Neuroradiologia, AUSL Romagna Ospedale Bufalini, Cesena, Italy
| | - Michele Romoli
- Neurologia e Stroke Unit H Bufalini Cesena, AUSL Romagna, Cesena, Italy
| | - Luigi Simonetti
- UO Neuroradiologia Ospedale Maggiore, IRCCS Istituto di Scienze Neurologiche di Bologna, Bologna, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | - Giovanni Orlandi
- Neurological Institute, University Hospital of Pisa, Italy, Italy
| | | | | | - Leonardo Renieri
- Neurovascular Interventional Unit, Careggi University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Stroke Unit, Azienda Ospedaliero Univarsitaria Careggi, Firenze, Italy
| | | | | | - Sandra Bracco
- Neuroradiologia Interventistica, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy
| | - Davide Castellano
- S.C. Radiologia e Neuroradiologia, Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Naldi
- , 2 Ospedale San Giovanni Bosco, S.C. Neurologia, Torino, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Universita degli Studi di Roma Sapienza, Roma, Lazio, Italy
| | - Ettore Nicolini
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
| | - Bruno Del Sette
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Laura Malfatto
- Neurology and Stroke Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Allegretti
- Department of Neuroradiology, S. Corona Hospital, Pietra Ligure, Italy
| | | | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Saletti
- Servizio di Neuroradiologia, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Neurology Division-Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Elvis Lafe
- UOC Radiologia Diagnostica Per Immagini 2, Neuroradiologia, Policlinico IRCCS San Matteo, Pavia, Italy
| | - Anna Cavallini
- UO Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Mauro Bergui
- Università Torino Dipartimento Neuroscienze, Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Giovanni Bosco
- Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paola Feraco
- U.O.C. Neuroradiologia Diagnostica e Radiologia Interventistica, Ospedale Santa Chiara, Trento, Italy
| | - Valeria Bignamini
- U.O.C Neurologia, Ospedale Santa Chiara, APSS di Trento, Trento, Italy
| | - Nicolò Mandruzzato
- Neuroradiology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Federica Vit
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | | | - Simone Comelli
- Vascular and Interventional Neuroradiology Department, ARNAS G. Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neuroscience Department, ARNAS G. Brotzu, Cagliari, Italy
| | | | | | - Giacomo Cester
- Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy
| | - Federica Viario
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | | | | | - Pietro Filauri
- UOSD Radiologia Interventistica, p.o. Avezzano, AQ, Italy
| | - Simona Sacco
- UOC Neurologia e Stroke Unit, p.o. Avezzano, AQ, Italy
| | - Andrea Giorgianni
- UOC Neuroradiologia, ASST Sette Laghi Varese, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | - Mariangela Piano
- Interventional Neuroradiology Unit, Ospedale Niguarda, Milano, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit AO "SS. Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Federica Sepe
- Neurology Unit AO "SS. Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | | | | | - Emilio Lozupone
- Department of Neuroradiology, Vito Fazzi Hospital, Lecce, Italy
| | - Antonio Fasano
- Department of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | - Alessio Comai
- Neuroradiologia, Ospedale Provinciale di Bolzano, Bolzano, Italy
| | | | - Stefano Bruni
- Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Mauro Silvestrini
- Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Luigi Chiumarulo
- UOS Neuroradiologia Interventistica, AOU Consorziale Policlinico, Policlinico Bari, Italy
| | | | - Marco Pavia
- Neuroradiologia, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Invernizzi
- Stroke Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy
| | | | - Alessandro Pedicelli
- Dipartimento di Diagnostica per Immagini, UOSA Neuroradiologia Interventistica, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italy
| | - Giovanni Frisullo
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, UOC Neurologia, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pietro Amistà
- Neuroradiologia, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Monia Russo
- Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Massimiliano Allegritti
- Dipartimento di Diagnostica per Immagini, Azienda Ospedaliera S. Maria Terni Angiografia Diagostica e Terapeutica, Azienda Ospedaliera "S. Maria", Terni, Italy
| | - Stefano Caproni
- Neurologia e Stroke Unit, Dipartimento di Neuroscienze, Azienda Ospedaliera "S. Maria", Terni, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Consultant at IRCCS Neuromed, Pozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Roma, Italy
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4
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Sallustio F, Pracucci G, Cappellari M, Saia V, Mascolo AP, Marrama F, Gandini R, Koch G, Diomedi M, D'Agostino F, Rocco A, Da Ros V, Wlderk A, Nezzo M, Argirò R, Morosetti D, Renieri L, Nencini P, Vallone S, Zini A, Bigliardi G, Pitrone A, Grillo F, Bracco S, Tassi R, Bergui M, Naldi A, Carità G, Casetta I, Gasparotti R, Magoni M, Simonetti L, Haznedari N, Paolucci M, Mavilio N, Malfatto L, Menozzi R, Genovese A, Cosottini M, Orlandi G, Comai A, Franchini E, Pedicelli A, Frisullo G, Puglielli E, Casalena A, Cester G, Baracchini C, Castellano D, Di Liberto A, Ricciardi GK, Chiumarulo L, Petruzzellis M, Lafe E, Persico A, Cavasin N, Critelli A, Semeraro V, Tinelli A, Giorgianni A, Carimati F, Auteri W, Rizzuto S, Biraschi F, Nicolini E, Ferrari A, Melis M, Calia S, Tassinari T, Nuzzi NP, Corato M, Sacco S, Squassina G, Invernizzi P, Gallesio I, Ruiz L, Dui G, Carboni N, Amistà P, Russo M, Maiore M, Zanda B, Craparo G, Mannino M, Inzitari D, Toni D, Mangiafico S. Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke. Acta Neurol Belg 2022; 123:475-485. [PMID: 36056270 DOI: 10.1007/s13760-022-02067-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/11/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Fabrizio Sallustio
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. .,Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.
| | | | - Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Alfredo Paolo Mascolo
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Federico Marrama
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Gandini
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Giacomo Koch
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Federica D'Agostino
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Alessandro Rocco
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Valerio Da Ros
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Andrea Wlderk
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marco Nezzo
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Renato Argirò
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Daniele Morosetti
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Leonardo Renieri
- Interventional Neuroradiology Unit, Ospedale Careggi-University Hospital, Florence, Italy
| | - Patrizia Nencini
- Stroke Unit, Ospedale Careggi-University Hospital, Florence, Italy
| | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Neurology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy
| | - Antonio Pitrone
- Neuroradiology Unit, Azienda Ospedaliera Universitaria Policlinico Messina, Messina, Italy
| | - Francesco Grillo
- Stroke Unit, Azienda Ospedaliera Universitaria Policlinico Messina, Messina, Italy
| | - Sandra Bracco
- Interventional Neuroradiology Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Ospedale S. Maria Delle Scotte-University Hospital, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Andrea Naldi
- Stroke Unit, Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Giuseppe Carità
- Interventional Neuroradiology Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Ilaria Casetta
- Neurology Division, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | | | - Luigi Simonetti
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche, Bellaria Hospital, Bologna, Italy
| | - Nicolò Haznedari
- Interventional Neuroradiology Unit, AUSL Romagna Cesena, Cesena, Italy
| | - Matteo Paolucci
- Neurology and Stroke Unit, AUSL Romagna Cesena, Cesena, Italy
| | - Nicola Mavilio
- Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genoa, Italy
| | | | - Roberto Menozzi
- Interventional Neuroradiology Unit, Ospedale Universitario, Parma, Italy
| | | | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Orlandi
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | | | | | | | | | - Edoardo Puglielli
- Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy
| | | | - Giacomo Cester
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria, Padua, Italy
| | | | - Davide Castellano
- Interventional Neuroradiology Unit, Ospedale San Giovanni Bosco, Turin, Italy
| | | | | | - Luigi Chiumarulo
- Interventional Neuroradiology Unit, AOU Consorziale Policlinico, Bari, Italy
| | | | - Elvis Lafe
- Diagnostic Radiology and Interventional Neuroradiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Persico
- Cerebrovascular Disease and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Nicola Cavasin
- Neuroradiology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Adriana Critelli
- Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | | | | | - Andrea Giorgianni
- Neuroradiology Department, Ospedale di Circolo di Varese, ASST-Sette Laghi, Varese, Italy
| | - Federico Carimati
- Neurology and Stroke Unit, Ospedale di Circolo di Varese, ASST-Sette Laghi, Varese, Italy
| | - William Auteri
- Neuroradiology Unit, Azienda Ospedaliera Cosenza, Cosenza, Italy
| | | | - Francesco Biraschi
- Interventional Neuroradiology Unit, University of Rome La Sapienza, Rome, Italy
| | | | - Antonio Ferrari
- Interventional Neuroradiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neuroscience Department, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Stefano Calia
- Neuroradiology Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Tiziana Tassinari
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | | | - Manuel Corato
- Stroke Unit, IRCCS Humanitas Rozzano, Rozzano, Milano, Italy
| | - Simona Sacco
- Department of Clinical Sciences and Biotechnology, Avezzano, L'Aquila, Italy
| | - Guido Squassina
- Neuroradiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Luigi Ruiz
- Neurology Department, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Giovanni Dui
- Interventional Radiology, Ospedale San Francesco, Nuoro, Italy
| | - Nicola Carboni
- Neurology and Stroke Unit, Ospedale San Francesco, Nuoro, Italy
| | - Pietro Amistà
- Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Monia Russo
- Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Mario Maiore
- Neuroradiology Unit, Azienda Ospedaliera Universitaria SS Annunziata, Sassari, Italy
| | - Bastianina Zanda
- Stroke Unit, Azienda Ospedaliera Universitaria SS Annunziata, Sassari, Italy
| | - Giuseppe Craparo
- Interventional Radiology, Ospedale Civico e Benfratelli, Palermo, Italy
| | - Marina Mannino
- Neurology Unit, Ospedale Civico e Benfratelli, Palermo, Italy
| | | | - Danilo Toni
- Stroke Unit, University of Rome La Sapienza, Rome, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Unit, Ospedale Careggi-University Hospital, Florence, Italy
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5
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Casetta I, Fainardi E, Pracucci G, Saia V, Sallustio F, da Ros V, Nappini S, Nencini P, Bigliardi G, Vinci S, Grillo F, Bracco S, Tassi R, Bergui M, Cerrato P, Saletti A, De Vito A, Gasparotti R, Magoni M, Simonetti L, Zini A, Ruggiero M, Longoni M, Castellan L, Malfatto L, Castellini P, Cosottini M, Comai A, Franchini E, Lozupone E, Della Marca G, Puglielli E, Casalena A, Baracchini C, Savio D, Duc E, Ricciardi G, Cappellari M, Chiumarulo L, Petruzzellis M, Cavallini A, Cavasin N, Critelli A, Burdi N, Boero G, Giorgianni A, Versino M, Biraschi F, Nicolini E, Comelli S, Melis M, Padolecchia R, Tassinari T, Paolo Nuzzi N, Marcheselli S, Sacco S, Invernizzi P, Gallesio I, Ferrandi D, Fancello M, Valeria Saddi M, Russo M, Pischedda A, Baule A, Mannino M, Florio F, Inchingolo V, Elena Flacco M, Romano D, Silvagni U, Inzitari D, Mangiafico S, Toni D. Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study. Eur Stroke J 2022; 7:151-157. [PMID: 35647312 PMCID: PMC9134778 DOI: 10.1177/23969873221091648] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/14/2022] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND AND PURPOSE We sought to investigate whether there are gender differences in clinical outcome after stroke due to large vessel occlusion (LVO) after mechanical thrombectomy (EVT) in a large population of real-world patients. METHODS From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke due to large vessel occlusion. We compared clinical and safety outcomes in men and women who underwent EVT alone or in combination with intravenous thrombolysis (IVT) in the total population and in a Propensity Score matched set. RESULTS Among 3422 patients included in the study, 1801 (52.6%) were women. Despite older age at onset (mean 72.4 vs 68.7; p < 0.001), and higher rate of atrial fibrillation (41.7% vs 28.6%; p < 0.001), women had higher probability of 3-month functional independence (adjusted odds ratio-adjOR 1.19; 95% CI 1.02-1.38), of complete recanalization (adjOR 1.25; 95% CI 1.09-1.44) and lower probability of death (adjOR 0.75; 95% CI 0.62-0.90). After propensity-score matching, a well-balanced cohort comprising 1150 men and 1150 women was analyzed, confirming the same results regarding functional outcome (3-month functional independence: OR 1.25; 95% CI 1.04-1.51), and complete recanalization (OR 1.29; 95% CI 1.09-1.53). CONCLUSIONS Subject to the limitations of a non-randomized comparison, women with stroke due to LVO treated with mechanical thrombectomy had a better chance to achieve complete recanalization, and 3-month functional independence than men. The results could be driven by women who underwent combined treatment.
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Affiliation(s)
- Ilaria Casetta
- Clinical Neurology, University of
Ferrara, Ferrara, Italy
| | | | | | - Valentina Saia
- Hospital Santa Corona Pietra Ligure,
Pietra Ligure, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Andrea Saletti
- Azienda Ospedaliero Universitaria di
Ferrara, Ferrara, Italy
| | | | | | - Mauro Magoni
- Azienda Socio Sanitaria Territoriale
degli Spedali Civili di Brescia, Brescia, Italy
| | | | - Andrea Zini
- IRCCS Istituto Delle Scienze
Neurologiche di Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrica Duc
- Ospedale San Giovanni Bosco, Torino,
Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Francesco Florio
- Fondazione di Religione e di Culto
Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Inchingolo
- Fondazione di Religione e di Culto
Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | | | - Danilo Toni
- University of Rome La Sapienza, RM,
Roma, Italy
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6
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Cappellari M, Saia V, Pracucci G, Enrico F, Consoli A, Nappini S, Castellan L, Bracco S, Bergui M, Cosottini M, Vangosa AB, Vinci S, Ruggiero M, Puglielli E, Chiumarulo L, Cester G, Comelli C, Silvagni U, Morosetti D, Caldiera V, Cavasin N, Ledda V, Sanfilippo G, Saletti A, Filauri P, Gallesio I, Nuzzi NP, Amistá P, Zivelonghi C, Plebani M, Pavia M, Romano D, Biraschi F, Menozzi R, Gasparotti R, Giorgianni A, Zini A, Inzitari D, Toni D, Mangiafico S. Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery. J Neurol 2021; 269:1013-1023. [PMID: 34797435 DOI: 10.1007/s00415-021-10898-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Careggi Collateral Score (CCS) (qualitative-quantitative evaluation) was developed from a single-centre cohort as an angiographic score to describe both the extension and effectiveness of the pial collateral circulation in stroke patients with occlusion of the anterior circulation. We aimed to examine the association between CCS (quantitative evaluation) and 3-month modified Rankin Scale (mRS) score in a large multi-center cohort of patients receiving thrombectomy for stroke with occlusion of middle cerebral artery (MCA). METHODS We conducted a study on prospectively collected data from 1284 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. According to the extension of the retrograde reperfusion in the cortical anterior cerebral artery (ACA)-MCA territories, CCS ranges from 0 (absence of retrograde filling) to 4 (visualization of collaterals until the alar segment of the MCA). RESULTS Using CCS of 4 as reference, CCS grades were associated in the direction of unfavourable outcome on 3-month mRS shift (0 to 6); significant difference was found between CCS of 0 and CCS of 1 and between CCS of 3 and CCS of 4. CCS ≥ 3 was the optimal cut-off for predicting 3-month excellent outcome, while CCS ≥ 1 was the optimal cut-off for predicting 3-month survival. CCS of 0 and CCS < 3 were associated in the direction of unfavourable recanalization on TICI shift (0 to 3) compared with CCS ≥ 1 and CCS ≥ 3, respectively. Compared with CCS ≥ 3 as reference, CCS of 0 and CCS 1 to 2 were associated in the direction of unfavourable recanalization on TICI shift. There was no evidence of heterogeneity of effects of successful recanalization and procedure time ≤ 60 min on 3-month mRS shift across CCS categories. CONCLUSION The CCS could provide a future advantage for improving the prognosis in patients receiving thrombectomy for stroke with M1 or M1-M2 segment of the MCA occlusion.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | - Valentina Saia
- Neurology and Stroke Unit, S. Corona Hospital, Pietra Ligure, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Fainardi Enrico
- Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Firenze, Italy
| | - Arturo Consoli
- Service de Neuroradiologie Diagnostique et Thérapeutique Hôpital Foch, Suresnes, France.,Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy
| | - Sergio Nappini
- Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy
| | - Lucio Castellan
- Department of Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Sandra Bracco
- Unit of Neuroimaging and Neurointervention, University Hospital of Siena, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Sergio Vinci
- UOC Neuroradiology, Department of Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Maria Ruggiero
- Department of Neuroradiology, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy
| | - Luigi Chiumarulo
- UOS Neuroradiologia Interventistica, AOU Consorziale Policlinico, Bari, Italy
| | - Giacomo Cester
- Department of Diagnostic Imaging and Interventional Radiology, Neuroradiology, Padua University Hospital, Padua, Italy
| | - Chiara Comelli
- Interventional Neuroradiology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Umberto Silvagni
- Interventional Neuroradiology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Daniele Morosetti
- Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
| | | | - Nicola Cavasin
- Neuroradiology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Valeria Ledda
- Vascular and Interventional Neuroradiology Department, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Giuseppina Sanfilippo
- Radiologia e Neuroradiologia Diagnostica e Interventistica, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Saletti
- Interventional Neuroradiology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Pietro Filauri
- Neuroradiology Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Ivan Gallesio
- Neuroradiological Unit, Department of Radiology, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | | | - Pitero Amistá
- Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Cecilia Zivelonghi
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | - Mauro Plebani
- Neuroradiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Pavia
- Neuroradiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Daniele Romano
- UOC Neuroradiologia, AUO S. Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Francesco Biraschi
- Department of Human Neurosciences, Interventional Neuroradiology, Università degli Studi di Roma Sapienza, Rome, Italy
| | | | | | - Andrea Giorgianni
- Neuroradiology Department, Ospedale di Circolo-ASST Sette Laghi, Varese, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Domenico Inzitari
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Barone M, Suppressa P, Viggiani MT, Lenato GM, Scardapane A, Chiumarulo L, Ambrosini N, Leo AD, Sabbà C. Minimal portosystemic encephalopathy: A new nosological entity in patients with hereditary haemorrhagic telangiectasia. Eur J Intern Med 2021; 90:43-48. [PMID: 34020869 DOI: 10.1016/j.ejim.2021.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Portosystemic shunts in Hereditary Haemorrhagic Telangiectasia (HHT) are often overlooked by conventional imaging although they could reduce hepatic clearance of gut-derived toxins. AIMS To evaluate, the presence of subclinical neurological alterations (SNAs), that we named "minimal portosystemic encephalopathy" (mPSE) in HHT patients without advanced liver disease (ALD). METHODS In this cross sectional study, consecutive HHT outpatients were firstly screened by critical flicker frequency (CFF) test (abnormal ≤39Hz), and the simplified animal naming test (S-ANT1) (abnormal <15) was used to confirm the diagnosis of mPSE. Furthermore, we evaluated the effect of lactulose administration on mPSE. Multi-slice CT, cerebral dynamic magnetic resonance, laboratory analyses and transient elastography were also used. RESULTS None of the 37 enrolled patients showed portosystemic shunts at imaging techniques. However, 33 patients had normal CFF values (CFF-) and 4 displayed CFF alterations (37.0±0.7Hz, CFF+). The S-ANT1 confirmed an impaired neurological performance (10.2±2.8) in CFF+ patients thus confirming the presence of mPSE. Noteworthy, lactulose administration determined a CFF increase (39.1±0.4Hz) and S-ANT1 normalization in these patients. Neither mPSE- nor mPSE+ patients had ALD and showed similar demographic, clinical and laboratory parameters. Finally, no mPSE+ patient showed radiologically-detectable brain vascular malformations or other brain abnormalities at imaging. CONCLUSIONS HHT patients represent a human model of mPSE secondary to portosystemic shunts escaping radiological detection. mPSE evaluation should be incorporated in HHT surveillance protocols since it can affect both health-related/social aspects and pharmacokinetics of orally administered drugs with a narrow therapeutic index and high hepatic first-pass uptake.
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Affiliation(s)
- Michele Barone
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, (D.E.T.O.), University of Bari Aldo Moro, Policlinico University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy.
| | - Patrizia Suppressa
- "Frugoni" Internal Medicine Unit, Centre for Rare Diseases, Interdepartmental Centre for Hereditary Haemorrhagic Telangiectasia, Interdisciplinary Department of Medicine (D.I.M.), VascERN HHT Reference Centre, University of Bari Aldo Moro, Policlinico University Hospital, Bari, Italy
| | - Maria Teresa Viggiani
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, (D.E.T.O.), University of Bari Aldo Moro, Policlinico University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Gennaro Mariano Lenato
- "Frugoni" Internal Medicine Unit, Centre for Rare Diseases, Interdepartmental Centre for Hereditary Haemorrhagic Telangiectasia, Interdisciplinary Department of Medicine (D.I.M.), VascERN HHT Reference Centre, University of Bari Aldo Moro, Policlinico University Hospital, Bari, Italy
| | - Arnaldo Scardapane
- Interdisciplinary Department of Medicine-Radiology Unit, University of Bari Aldo Moro, Policlinico University Hospital, Bari, Italy
| | - Luigi Chiumarulo
- Neuroradiology Unit, Policlinico University Hospital, Bari, Italy
| | - Nicola Ambrosini
- "Frugoni" Internal Medicine Unit, Centre for Rare Diseases, Interdepartmental Centre for Hereditary Haemorrhagic Telangiectasia, Interdisciplinary Department of Medicine (D.I.M.), VascERN HHT Reference Centre, University of Bari Aldo Moro, Policlinico University Hospital, Bari, Italy
| | - Alfredo Di Leo
- Gastroenterology Unit, Department of Emergency and Organ Transplantation, (D.E.T.O.), University of Bari Aldo Moro, Policlinico University Hospital, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Carlo Sabbà
- "Frugoni" Internal Medicine Unit, Centre for Rare Diseases, Interdepartmental Centre for Hereditary Haemorrhagic Telangiectasia, Interdisciplinary Department of Medicine (D.I.M.), VascERN HHT Reference Centre, University of Bari Aldo Moro, Policlinico University Hospital, Bari, Italy
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8
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Piano M, Lozupone E, Sgoifo A, Nuzzi NP, Asteggiano F, Pero G, Quilici L, Iannucci G, Cerini P, Comelli C, Peschillo S, Princiotta C, Pedicelli A, Limbucci N, Ganci G, Trasimeni G, Ciceri E, Faragò G, Giorgianni A, DE Nicola M, Remida P, Lafe E, Mardighian D, Ruggiero M, Lazzarotti GA, Cavasin N, Castellan L, Chiumarulo L, Burdi N, Paolucci A, Briganti F, Natrella M, Florio FP, Pavia M, Gallesio I, Lucente G, Gozzoli L, Caputo N, Vagnarelli S, Boccardi E, Valvassori L. Long-term follow-up of the Derivo® Embolization Device (DED®) for intracranial aneurysms: the Italian Multicentric Registry. J Neurosurg Sci 2021; 65:361-368. [PMID: 33879762 DOI: 10.23736/s0390-5616.21.05300-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The flow-diverter devices (FDDs) safety and effectiveness have been demonstrated by large series and meta-analyses. Due to the high occlusion rates and the acceptable morbidity rates of FDDs, the indications for their use are continuously expanding. We presented our Italian multicentric experience using the second generation of DERIVO® Embolization Device (DED®; Acandis, Pforzheim, Germany) to cure cerebral aneurysms, evaluating both middle and long-term safety and efficacy of this device. METHODS Between July 2016 and September 2017 we collected 109 consecutive aneurysms in 108 patients treated using DED® during 109 endovascular procedures in 34 Italian centers (100/109 aneurysms were unruptured, 9/109 were ruptured). The collected data included patient demographics, aneurysm location and characteristics, baseline angiography, adverse event and serious adverse event information, morbidity and mortality rates, and pre- and post-treatment modified Rankin Scale scores. Midterm and long-term clinical, angiographic and cross-sectional CT/MR follow-up were recorded and collected until December 2018. RESULTS In 2/109 cases, DED® placement was classified as technical failures. The overall mortality and morbidity rates were respectively 6.5% and 5.5%. Overall DERIVO® related mortality and morbidity rates were respectively 0% and 4.6% (5 out of 108 patients). Midterm neuroimaging follow-up showed the complete or nearly complete occlusion of the aneurysm in 90% cases, which became 93% at long-term follow-up. Aneurysmal sac shrinking was observed in 65% of assessable aneurysms. CONCLUSIONS Our multicentric experience using DED® for endovascular treatment of unruptured and ruptured aneurysms showed a high safety and efficacy profile, substantially equivalent or better compared to the other FDDs.
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Affiliation(s)
| | | | | | | | | | - Guglielmo Pero
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Luca Quilici
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Paolo Cerini
- Maggiore della Carità University Hospital, Novara, Italy
| | | | | | | | | | | | | | | | - Elisa Ciceri
- Azienda Ospedaliera Universitaria Integrata di Verona (AOUI-Vr), Verona, Italy
| | - Giuseppe Faragò
- IRCCS Neurologic Institute C. Besta Foundation, Milan, Italy
| | | | | | - Paolo Remida
- ASST San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Elvis Lafe
- IRCCS Polyclinic San Matteo Foundation, Pavia, Italy
| | | | | | | | | | | | | | | | | | | | | | - Francesco P Florio
- Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy
| | | | - Ivan Gallesio
- AON SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
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9
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Sallustio F, Saia V, Marrama F, Pracucci G, Gandini R, Koch G, Mascolo AP, D'Agostino F, Rocco A, Argiro' R, Nezzo M, Morosetti D, Wlderk A, Da Ros V, Diomedi M, Renieri L, Nencini P, Vallone S, Zini A, Bigliardi G, Caragliano A, Francalanza I, Bracco S, Tassi R, Bergui M, Naldi A, Saletti A, De Vito A, Gasparotti R, Magoni M, Cirillo L, Commodaro C, Biguzzi S, Castellan L, Malfatto L, Menozzi R, Grisendi I, Cosottini M, Orlandi G, Comai A, Franchini E, D'Argento F, Frisullo G, Puglielli E, Casalena A, Causin F, Baracchini C, Boghi A, Chianale G, Augelli R, Cappellari M, Chiumarulo L, Petruzzellis M, Sgreccia A, Tosi P, Cavasin N, Critelli A, Semeraro V, Boero G, Vizzari F, Cariddi LP, Di Benedetto O, Pugliese P, Iacobucci M, De Michele M, Fusaro F, Moller J, Allegretti L, Tassinari T, Nuzzi NP, Marcheselli S, Sacco S, Pavia M, Invernizzi P, Gallesio I, Ruiz L, Zedda S, Rossi R, Amistà P, Russo M, Pintus F, Sanna A, Craparo G, Mannino M, Inzitari D, Mangiafico S, Toni D. Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries : The Italian Registry of Endovascular Treatment in Acute Stroke. Clin Neuroradiol 2020; 31:21-29. [PMID: 33301052 DOI: 10.1007/s00062-020-00980-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/12/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. METHODS A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. RESULTS Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. CONCLUSION Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.
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Affiliation(s)
- Fabrizio Sallustio
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy. .,Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy.
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Federico Marrama
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Roberto Gandini
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Giacomo Koch
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.,Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Alfredo Paolo Mascolo
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Federica D'Agostino
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Alessandro Rocco
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Renato Argiro'
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marco Nezzo
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Daniele Morosetti
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Andrea Wlderk
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Valerio Da Ros
- Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Leonardo Renieri
- Interventional Neuroradiology Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy
| | - Andrea Zini
- IRCCS Istituto di Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy
| | - Antonio Caragliano
- Interventional Neuroradiology Unit, Policlinico G. Martino, Messina, Italy
| | | | - Sandra Bracco
- Interventional Neuroradiology Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Andrea Naldi
- Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Andrea Saletti
- Interventional Neuroradiology Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Neurology Division and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | | | - Luigi Cirillo
- IRCCS Istituto di Scienze Neurologiche di Bologna, Neuroradiology Unit, Ospedale Bellaria, Bologna University-DIMES, Bologna, Italy
| | | | - Sara Biguzzi
- Neurology and Stroke Unit, AUSL Romagna Cesena, Cesena, Italy
| | - Lucio Castellan
- Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genova, Italy
| | | | - Roberto Menozzi
- Interventional Neuroradiology Unit, Ospedale Universitario, Parma, Italy
| | | | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Orlandi
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | | | | | | | | | - Edoardo Puglielli
- Interventional Radiology Unit, Ospedale Civile Mazzini, Teramo, Italy
| | | | - Francesco Causin
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria, Padova, Italy
| | | | - Andrea Boghi
- Interventional Neuroradiology Unit, Ospedale San Giovanni Bosco, Torino, Italy
| | | | - Raffaele Augelli
- Neuroradiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luigi Chiumarulo
- Interventional Neuroradiology Unit, AOU Consorziale Policlinico, Bari, Italy
| | | | - Alessandro Sgreccia
- Diagnostic Radiology and Interventional Neuroradiology, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piera Tosi
- Cerebrovascular Disease and Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Nicola Cavasin
- Neuroradiology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Adriana Critelli
- Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | | | - Giovanni Boero
- Neurology Unit, Osp. "SS. Annunziata"-ASL TA, Taranto, Italy
| | - Francesco Vizzari
- Neuroradiology Department, Ospedale di Circolo di Varese, ASST-Sette Laghi, Varese, Italy
| | | | | | | | - Marta Iacobucci
- Interventional Neuroradiology Unit, University of Rome La Sapienza, Roma, Italy
| | | | - Federico Fusaro
- Interventional Neuroradiology, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Jessica Moller
- Stroke Unit, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Luca Allegretti
- Neuroradiology Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Tiziana Tassinari
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | | | | | - Simona Sacco
- Department of Clinical Sciences and Biotechnology, University of L'Aquila, Avezzano, L'Aquila, Italy
| | - Marco Pavia
- Neuroradiology Unit, Fondazione Poliambulanza, Brescia, Italy
| | | | - Ivan Gallesio
- Neuroradiology Unit, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Luigi Ruiz
- Neurology Department, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Sandro Zedda
- Interventional Radiology, Ospedale San Francesco, Nuoro, Italy
| | - Rosario Rossi
- Neurology and Stroke Unit, Ospedale San Francesco, Nuoro, Italy
| | - Pietro Amistà
- Neuroradiology Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | - Monia Russo
- Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy
| | | | | | - Giuseppe Craparo
- Interventional Radiology, Ospedale Civico e Benfratelli, Palermo, Italy
| | - Marina Mannino
- Neurology Unit, Ospedale Civico e Benfratelli, Palermo, Italy
| | | | - Salvatore Mangiafico
- Interventional Neuroradiology Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Danilo Toni
- Stroke Unit, University of Rome La Sapienza, Roma, Italy
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10
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Salsano G, Pracucci G, Mavilio N, Saia V, Bandettini di Poggio M, Malfatto L, Sallustio F, Wlderk A, Limbucci N, Nencini P, Vallone S, Zini A, Bigliardi G, Velo M, Francalanza I, Gennari P, Tassi R, Bergui M, Cerrato P, Carità G, Azzini C, Gasparotti R, Magoni M, Isceri S, Commodaro C, Cordici F, Menozzi R, Latte L, Cosottini M, Mancuso M, Comai A, Franchini E, Alexandre A, Marca GD, Puglielli E, Casalena A, Causin F, Baracchini C, Di Maggio L, Naldi A, Grazioli A, Forlivesi S, Chiumarulo L, Petruzzellis M, Sanfilippo G, Toscano G, Cavasin N, Adriana C, Ganimede MP, Prontera MP, Giorgianni A, Mauri M, Auteri W, Petrone A, Cirelli C, Falcou A, Corraine S, Piras V, Ganci G, Tassinari T, Nuzzi NP, Corato M, Sacco S, Squassina G, Invernizzi P, Gallesio I, Ferrandi D, Dui G, Deiana G, Amistà P, Russo M, Pintus F, Baule A, Craparo G, Mannino M, Castellan L, Toni D, Mangiafico S. Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke. Int J Stroke 2020; 16:818-827. [PMID: 33283685 DOI: 10.1177/1747493020976681] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. AIMS We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. METHODS From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. RESULTS The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21-2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13-8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66-12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31-0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97-0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19-0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6-0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02-1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02-1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25-2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26-3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08-2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55-0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. CONCLUSIONS Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.
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Affiliation(s)
- Giancarlo Salsano
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Giovanni Pracucci
- Department of NEUROFARBA, Neuroscience Section, University of Florence, Florence, Italy
| | - Nicola Mavilio
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Valentina Saia
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Monica Bandettini di Poggio
- IRCCS San Martino Policlinic Hospital, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genoa, Italy
| | - Laura Malfatto
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Fabrizio Sallustio
- Imaging and Interventional Radiology and Stroke Unit, Policlinico Tor Vergata, Roma, Italy
| | - Andrea Wlderk
- Imaging and Interventional Radiology and Stroke Unit, Policlinico Tor Vergata, Roma, Italy
| | - Nicola Limbucci
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
| | - Stefano Vallone
- Neuroradiology and Neurology, Ospedale Civile S. Agostino-Estense, University Hospital, Modena, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center and Neuroradiology, Maggiore Hospital, Bologna, Italy
| | - Guido Bigliardi
- Neuroradiology and Neurology, Ospedale Civile S. Agostino-Estense, University Hospital, Modena, Italy
| | - Mariano Velo
- Neuroradiology and Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino Messina, Italy
| | - Isabella Francalanza
- Neuroradiology and Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Policlinico G. Martino Messina, Italy
| | - Paola Gennari
- Neuroradiology and Neurology, 161157AOU Senese, Siena, Italy
| | - Rossana Tassi
- Neuroradiology and Neurology, 161157AOU Senese, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Giuseppe Carità
- Neuroradiology and Neurology, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Cristiano Azzini
- Neuroradiology and Neurology, Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | - Mauro Magoni
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Salvatore Isceri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center and Neuroradiology, Maggiore Hospital, Bologna, Italy
| | - Christian Commodaro
- Department of Neuroradiology, Neurology and Stroke Unit, Cesena-Forlì, AUSL Romagna Azienda Ospedaliera, Cesena, Italy
| | - Francesco Cordici
- Department of Neuroradiology, Neurology and Stroke Unit, Cesena-Forlì, AUSL Romagna Azienda Ospedaliera, Cesena, Italy
| | - Roberto Menozzi
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy
| | - Lilia Latte
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Michelangelo Mancuso
- Department of Translational Research and New Technologies in Medicine and Surgery, 9310University of Pisa, Pisa, Italy
| | - Alessio Comai
- Radiology Unit and Stroke Unit, Ospedale Centrale, Bolzano, Italy
| | - Enrica Franchini
- Radiology Unit and Stroke Unit, Ospedale Centrale, Bolzano, Italy
| | - Andrea Alexandre
- Institute of Neuroradiology and Neurology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Giacomo Della Marca
- Institute of Neuroradiology and Neurology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | | | | | - Francesco Causin
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | - Claudio Baracchini
- Stroke Unit and Neurosonology Laboratory, Department of Neuroscience, University of Padua School of Medicine, Padua, Italy
| | - Luca Di Maggio
- Neuroradiology and Neurology, 18698Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Naldi
- Neuroradiology and Neurology, 18698Ospedale San Giovanni Bosco, Torino, Italy
| | - Andrea Grazioli
- UOC Neuroradiologia, DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Forlivesi
- UOC Neuroradiologia, DAI Patologia e Diagnostica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Luigi Chiumarulo
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico, Bari, Italy
| | - Marco Petruzzellis
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico, Bari, Italy
| | - Giuseppina Sanfilippo
- Diagnostic and Interventional Neuroradiology Unit and Stroke Unit, IRCCS Mondino Foundation San Matteo Hospital, Pavia, Italy
| | - Gianpaolo Toscano
- Diagnostic and Interventional Neuroradiology Unit and Stroke Unit, IRCCS Mondino Foundation San Matteo Hospital, Pavia, Italy
| | - Nicola Cavasin
- Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Critelli Adriana
- Neuroradiology Unit and Neurology Unit, Ospedale dell'Angelo, USSL3 Serenissima, Mestre, Italy
| | - Maria Porzia Ganimede
- Interventional Radiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy
| | - Maria Pia Prontera
- Interventional Radiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy
| | - Andrea Giorgianni
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy
| | - Marco Mauri
- Neuroradiology Unit and Stroke Unit, Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy
| | - William Auteri
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Alfredo Petrone
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Carlo Cirelli
- Department of Human Neurosciences, Interventional Neuroradiology and Neurology, Università degli Studi di Roma Sapienza, Roma, Lazio, Italy
| | - Anne Falcou
- Department of Human Neurosciences, Interventional Neuroradiology and Neurology, Università degli Studi di Roma Sapienza, Roma, Lazio, Italy
| | - Simona Corraine
- Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Sardinia, Italy
| | - Valeria Piras
- Neuroscience Department, Azienda Ospedaliera G. Brotzu, Cagliari, Sardinia, Italy
| | - Giuseppe Ganci
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | - Tiziana Tassinari
- Neuroradiology Unit and Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy
| | | | - Manuel Corato
- IRCCS Humanitas Clinical and Research Center, Rozzano, Milano, Italy
| | - Simona Sacco
- Department of Clinical Scieces and Biotechnology, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Guido Squassina
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Paolo Invernizzi
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy
| | - Ivan Gallesio
- Department of Radiology and Neuroradiological Unit, Department of Neurology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo," Alessandria, Italy
| | - Delfina Ferrandi
- Department of Radiology and Neuroradiological Unit, Department of Neurology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo," Alessandria, Italy
| | - Giovanni Dui
- Radiology and Interventional Radiology Unit and Neurology Unit, 97998Ospedale San Francesco, Nuoro, Italy
| | - Gianluca Deiana
- Radiology and Interventional Radiology Unit and Neurology Unit, 97998Ospedale San Francesco, Nuoro, Italy
| | - Pietro Amistà
- Department of Neuroradiology and Neurology, Hospital of Rovigo, Rovigo, Italy
| | - Monia Russo
- Department of Neuroradiology and Neurology, Hospital of Rovigo, Rovigo, Italy
| | - Francesco Pintus
- Unit of Neuroradiology and Stroke Unit, Santissima Annunziata Hospital, Sassari, Italy
| | - Antonio Baule
- Unit of Neuroradiology and Stroke Unit, Santissima Annunziata Hospital, Sassari, Italy
| | - Giuseppe Craparo
- Department of Neuroradiology and Neurology, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Marina Mannino
- Department of Neuroradiology and Neurology, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Lucio Castellan
- IRCCS San Martino Policlinic Hospital, Neuroradiology and Neurology, Genoa, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Salvatore Mangiafico
- Interventional Neurovascular Unit and Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy
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Cappellari M, Pracucci G, Forlivesi S, Saia V, Limbucci N, Nencini P, Inzitari D, Da Ros V, Sallustio F, Vallone S, Bigliardi G, Zini A, Vinci SL, Dell'Aera C, Bracco S, Cioni S, Tassi R, Bergui M, Naldi A, Carità G, Azzini C, Casetta I, Gasparotti R, Magoni M, Castellan L, Finocchi C, Menozzi R, Scoditti U, Causin F, Viaro F, Puglielli E, Casalena A, Ruggiero M, Biguzzi S, Castellano D, Cavallo R, Lazzarotti GA, Orlandi G, Sgreccia A, Denaro MF, Cavasin N, Critelli A, Ciceri EFM, Bonetti B, Chiumarulo L, Petruzzelli M, Pellegrino C, Carimati F, Burdi N, Prontera MP, Auteri W, Petrone A, Guidetti G, Nicolini E, Ganci G, Sugo A, Filauri P, Sacco S, Squassina G, Invernizzi P, Nuzzi NP, Corato M, Amistà P, Gentile M, Barbero S, Schirru F, Craparo G, Mannino M, Simonetti L, Mangiafico S, Toni D. Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis. J Neurol 2020; 267:3731-3740. [PMID: 32712865 DOI: 10.1007/s00415-020-10098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/15/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intravenous thrombolysis (IVT)-ineligible patients undergoing direct thrombectomy tended to have poorer functional outcome as compared with IVT-eligible patients undergoing bridging therapy. We aimed to assess radiological and functional outcomes in large vessel occlusion-related stroke patients receiving direct thrombectomy in the presence of absolute exclusion criteria for IVT vs relative exclusion criteria for IVT and vs non-exclusion criteria for IVT. METHODS A cohort study on prospectively collected data from 2282 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke cohort for treatment with direct thrombectomy (n = 486, absolute exclusion criteria for IVT alone; n = 384, absolute in combination with relative exclusion criteria for IVT; n = 777, relative exclusion criteria for IVT alone; n = 635, non-exclusion criteria for IVT). RESULTS After adjustment for unbalanced variables (model 1), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.595, 95% CI 1.042-2.440) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.235, 95% CI 1.014-1.504). After adjustment for predefined variables (model 2: age, sex, pre-stroke mRS ≤ 1, NIHSS, occlusion in the anterior circulation, onset-to-groin time, and procedure time), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.235, 95% CI 1.014-1.504) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.246, 95% CI 1.039-1.495). No significant difference was found between the groups as regards any type of intracerebral hemorrhage and parenchymal hematoma within 24 h, successful and complete recanalization after procedure, and modified Rankin Scale score 0-2 at 3 months. After adjustment for predefined variables of model 2, ORs for death were higher in the presence of recent administration of IV heparin (OR: 2.077), platelet count < 100,000/mm3 (OR: 4.798), bacterial endocarditis (OR: 15.069), neoplasm with increased hemorrhagic risk (OR: 6.046), and severe liver disease (OR: 6.124). CONCLUSIONS Radiological outcomes were similar after direct thrombectomy in patients with absolute, relative, and non- exclusion criteria for IVT, while an increase of fatal outcome was observed in the presence of some absolute exclusion criterion for IVT.
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Affiliation(s)
- Manuel Cappellari
- USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | | | - Stefano Forlivesi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | | | | | | | | | | | - Stefano Vallone
- Ospedale Civile S.Agostino-Estense-University Hospital, Modena, Italy
| | - Guido Bigliardi
- Ospedale Civile S.Agostino-Estense-University Hospital, Modena, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | | | - Sandra Bracco
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Samuele Cioni
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Mauro Bergui
- Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Andrea Naldi
- Città della Salute e della Scienza-Molinette, Turin, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bruno Bonetti
- USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Pietro Filauri
- Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Simona Sacco
- Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Guido Squassina
- Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | | | | | | | | | - Mauro Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | | | | | | | - Luigi Simonetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
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Casetta I, Fainardi E, Saia V, Pracucci G, Padroni M, Renieri L, Nencini P, Inzitari D, Morosetti D, Sallustio F, Vallone S, Bigliardi G, Zini A, Longo M, Francalanza I, Bracco S, Vallone IM, Tassi R, Bergui M, Naldi A, Saletti A, De Vito A, Gasparotti R, Magoni M, Castellan L, Serrati C, Menozzi R, Scoditti U, Causin F, Pieroni A, Puglielli E, Casalena A, Sanna A, Ruggiero M, Cordici F, Di Maggio L, Duc E, Cosottini M, Giannini N, Sanfilippo G, Zappoli F, Cavallini A, Cavasin N, Critelli A, Ciceri E, Plebani M, Cappellari M, Chiumarulo L, Petruzzellis M, Terrana A, Cariddi LP, Burdi N, Tinelli A, Auteri W, Silvagni U, Biraschi F, Nicolini E, Padolecchia R, Tassinari T, Filauri P, Sacco S, Pavia M, Invernizzi P, Nuzzi NP, Marcheselli S, Amistà P, Russo M, Gallesio I, Craparo G, Mannino M, Mangiafico S, Toni D. Endovascular Thrombectomy for Acute Ischemic Stroke Beyond 6 Hours From Onset. Stroke 2020; 51:2051-2057. [DOI: 10.1161/strokeaha.119.027974] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background and Purpose:
To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice.
Methods:
From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours.
Results:
Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0–2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0–2 (odds ratio, 0.58 [95% CI, 0.43–0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients).
Conclusions:
This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.
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Affiliation(s)
- Ilaria Casetta
- Clinica Neurologica, University of Ferrara, (I.C., M.P.)
| | | | - Valentina Saia
- Stroke Unit, Santa Corona Hospital, Pietra Ligure (V.S.)
| | - Giovanni Pracucci
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Marina Padroni
- Clinica Neurologica, University of Ferrara, (I.C., M.P.)
| | - Leonardo Renieri
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence (L.R., S.M.)
| | - Patrizia Nencini
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Domenico Inzitari
- Stroke Unit, Careggi University Hospital, Florence (G.P., P.N., D.I.)
| | - Daniele Morosetti
- Diagnostic Imaging and Interventional Radiology Unit (D.M.), University of Rome Tor Vergata
| | | | - Stefano Vallone
- Interventional Neuroradiology Unit (S.V.), Ospedale Civile “S.Agostino-Estense”, AOU Modena
| | - Guido Bigliardi
- Stroke Unit (G.B.), Ospedale Civile “S.Agostino-Estense”, AOU Modena
| | - Andrea Zini
- Neurology and Stroke Unit, Maggiore Hospital, Bologna (A.Z.)
| | - Marcello Longo
- Interventional Neuroradiology Unit, Policlinico G Martino, Messina (M.L.)
| | | | - Sandra Bracco
- Neuroimaging and Neurointervention Unit (NINT), AOU Senese, Siena (S.B., I.M.V.)
| | - Ignazio M. Vallone
- Neuroimaging and Neurointervention Unit (NINT), AOU Senese, Siena (S.B., I.M.V.)
| | - Rossana Tassi
- Stroke Unit, University Hospital “S. Maria delle Scotte”, Siena (R.T.)
| | - Mauro Bergui
- Interventional Neuroradiology Unit, Città della Salute e della Scienza—Molinette, Turin (M.B.)
| | - Andrea Naldi
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin (A.N.)
| | - Andrea Saletti
- Interventional Neuroradiology Unit, University Hospital “Arcispedale S. Anna”, Ferrara (A.S.)
| | - Alessandro De Vito
- Stroke Unit, University Hospital “Arcispedale S. Anna”, Ferrara (A.D.V.)
| | | | | | - Lucio Castellan
- Interventional Neuroradiology Unit, IRCCS San Martino-IST, Genova (L.C.)
| | - Carlo Serrati
- Neurology and Stroke Unit, IRCCS San Martino-IST, Genova (C.S.)
| | - Roberto Menozzi
- Interventional Neuroradiology Unit (R.M.), University Hospital, Parma
| | | | | | - Alessio Pieroni
- Stroke Unit and Neurosonology Lab (A.P.), Padua University Hospital
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit (E.P.), Ospedale Civile “Mazzini”, Teramo
| | | | - Antioco Sanna
- Neuroradiology Unit (A.S., M.R.), “M. Bufalini” Hospital-AUSL Romagna, Cesena
| | - Maria Ruggiero
- Neuroradiology Unit (A.S., M.R.), “M. Bufalini” Hospital-AUSL Romagna, Cesena
| | | | - Luca Di Maggio
- Interventional Radiology and Neuroradiology Unit (L.D.M), San Giovanni Bosco Hospital, Torino
| | - Enrica Duc
- Neurology Unit (E.D.), San Giovanni Bosco Hospital, Torino
| | | | | | - Giuseppina Sanfilippo
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia (G.S., F.Z.)
| | - Federico Zappoli
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia (G.S., F.Z.)
| | | | - Nicola Cavasin
- Neuroradiology Unit (N.C.), Ospedale dell’Angelo—USSL3 Serenissima, Mestre
| | - Adriana Critelli
- Neurology Unit (A.C.), Ospedale dell’Angelo—USSL3 Serenissima, Mestre
| | | | | | | | | | | | - Alberto Terrana
- Neuroradiology Unit (A.T.), AOU Circolo, ASST-Settelaghi, Varese
| | | | - Nicola Burdi
- Interventional Radiology (N.B.), Ospedale SS. Annunziata, Taranto
| | | | - William Auteri
- Interventional Neuroradiology Unit, AO Annunziata, Cosenza (W.A., U.S.)
| | - Umberto Silvagni
- Interventional Neuroradiology Unit, AO Annunziata, Cosenza (W.A., U.S.)
| | | | - Ettore Nicolini
- Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.)
| | | | - Tiziana Tassinari
- Neurology and Stroke Unit (T.T.), S. Corona Hospital-ASL2 Savonese, Pietra Ligure
| | - Pietro Filauri
- Interventional Neuroradiology Unit, PO SS. Filippo e Nicola, Avezzano (P.F.)
| | - Simona Sacco
- Department of Applied Clinical Sciences e Biotechnology, University of L’Aquila, L’Aquila (S.S.)
| | - Marco Pavia
- Neuroradiology Unit (M.P.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia
| | - Paolo Invernizzi
- Neurology Unit (P.I.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia
| | - Nunzio P. Nuzzi
- Interventional Neuroradiology Unit (N.P.N.), Humanitas Research Hospital, Rozzano
| | - Simona Marcheselli
- Urgent Neurology and Stroke Unit (S.M.), Humanitas Research Hospital, Rozzano
| | - Pietro Amistà
- Interventional Neuroradiology Unit (P.A.), S. Maria della Misericordia Hospital, Rovigo
| | - Monia Russo
- Stroke Unit (M.R.), S. Maria della Misericordia Hospital, Rovigo
| | - Ivan Gallesio
- Neuroradiology Unit, SS. Antonio e Biagio e C. Arrigo Hospital, Alessandria (I.G.)
| | - Giuseppe Craparo
- Interventional Neuroradiology Unit (G.C.), Ospedale Civico-A.R.N.A.S., Palermo
| | | | - Salvatore Mangiafico
- Interventional Neuroradiology Unit, Careggi University Hospital, Florence (L.R., S.M.)
| | - Danilo Toni
- Emergency Department Stroke Unit, Sapienza University Hospital, Rome (E.N., D.T.)
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Cappellari M, Pracucci G, Forlivesi S, Saia V, Nappini S, Nencini P, Inzitari D, Greco L, Sallustio F, Vallone S, Bigliardi G, Zini A, Pitrone A, Grillo F, Musolino R, Bracco S, Tinturini R, Tassi R, Bergui M, Cerrato P, Saletti A, De Vito A, Casetta I, Gasparotti R, Magoni M, Castellan L, Malfatto L, Menozzi R, Scoditti U, Causin F, Baracchini C, Puglielli E, Casalena A, Ruggiero M, Malatesta E, Comelli C, Chianale G, Lauretti DL, Mancuso M, Lafe E, Cavallini A, Cavasin N, Critelli A, Ciceri EFM, Bonetti B, Chiumarulo L, Petruzzelli M, Giorgianni A, Versino M, Ganimede MP, Tinelli A, Auteri W, Petrone A, Guidetti G, Nicolini E, Allegretti L, Tassinari T, Filauri P, Sacco S, Pavia M, Invernizzi P, Nuzzi NP, Carmela Spinelli M, Amistà P, Russo M, Ferrandi D, Corraine S, Craparo G, Mannino M, Simonetti L, Toni D, Mangiafico S. General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke. Stroke 2020; 51:2036-2044. [DOI: 10.1161/strokeaha.120.028963] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA).
Methods:
We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke.
Results:
GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0–1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602–1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515–0.990). The rates of modified Rankin Scale score of 0–2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689–1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566–0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644–1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844–1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262–0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337–0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0–2 (aOR, 0.659 [95% CI, 0.538–0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095–1.823]).
Conclusions:
GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.
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Affiliation(s)
- Manuel Cappellari
- Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.)
| | - Giovanni Pracucci
- NEUROFARBA Department, University of Florence, Firenze, Italy (G.P., D.I.)
| | - Stefano Forlivesi
- Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.)
| | - Valentina Saia
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.)
| | - Sergio Nappini
- NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.)
| | - Patrizia Nencini
- NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.)
| | - Domenico Inzitari
- NEUROFARBA Department, University of Florence, Firenze, Italy (G.P., D.I.)
| | - Laura Greco
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico Tor Vergata, Rome, Italy (L.G., F.S.)
| | - Fabrizio Sallustio
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico Tor Vergata, Rome, Italy (L.G., F.S.)
| | - Stefano Vallone
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy (S.V., G.B.)
| | - Guido Bigliardi
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy (S.V., G.B.)
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Institute of the Neurological Sciences, Maggiore Hospital, Bologna, Italy (A.Z., L.S.)
| | - Antonio Pitrone
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino)
| | - Francesco Grillo
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino)
| | - Rosa Musolino
- Interventional Neuroradiology Unit and Stroke Unit, Policlinico G. Martino, Messina, Italy (A. Pitrone, F.G., R. Musolino)
| | - Sandra Bracco
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi)
| | - Rebecca Tinturini
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi)
| | - Rossana Tassi
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (S.B., R. Tinturini, R. Tassi)
| | - Mauro Bergui
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy (M.B., P.C.)
| | - Paolo Cerrato
- Interventional Neuroradiology Unit and Stroke Unit, Città della Salute e della Scienza-Molinette, Torino, Italy (M.B., P.C.)
| | - Andrea Saletti
- Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.)
| | - Alessandro De Vito
- Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.)
| | - Ilaria Casetta
- Neuroradiology Unit and Stroke Unit, Arcispedale S. Anna-University Hospital, Ferrara, Italy (A.S., A.D.V., I.C.)
| | - Roberto Gasparotti
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy (R.G., M. Magoni)
| | - Mauro Magoni
- Neuroradiology Unit and Stroke Unit, Spedali Civili, Brescia, Italy (R.G., M. Magoni)
| | - Lucio Castellan
- Interventional Neuroradiology Unit and Stroke Unit, IRCCS San Martino-IST, Genova, Italy (L. Castellan, L.M.)
| | - Laura Malfatto
- Interventional Neuroradiology Unit and Stroke Unit, IRCCS San Martino-IST, Genova, Italy (L. Castellan, L.M.)
| | - Roberto Menozzi
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy (R. Menozzi, U.S.)
| | - Umberto Scoditti
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Universitario, Parma, Italy (R. Menozzi, U.S.)
| | - Francesco Causin
- Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera-Universitaria, Padova, Italy (F.C., C.B.)
| | - Claudio Baracchini
- Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera-Universitaria, Padova, Italy (F.C., C.B.)
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit and Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy (E.P., A. Casalena)
| | - Alfonsina Casalena
- Vascular and Interventional Radiology Unit and Neurology Unit, Ospedale Civile Mazzini, Teramo, Italy (E.P., A. Casalena)
| | - Maria Ruggiero
- Neuroradiology Unit and Neurology Unit, Ospedale M. Bufalini, Cesena, Italy (M. Ruggiero, E.M.)
| | - Emanuele Malatesta
- Neuroradiology Unit and Neurology Unit, Ospedale M. Bufalini, Cesena, Italy (M. Ruggiero, E.M.)
| | - Chiara Comelli
- Interventional Neuroradiology Unit and Neurology Unit, Ospedale San Giovanni Bosco, Torino, Italy (C.C., G. Chianale)
| | - Gigliola Chianale
- Interventional Neuroradiology Unit and Neurology Unit, Ospedale San Giovanni Bosco, Torino, Italy (C.C., G. Chianale)
| | - Dario Luca Lauretti
- Neuroradiology Unit and Neurology Unit, Ospedale Cisanello, Pisa, Italy (D.L.L., M. Mancuso)
| | - Michelangelo Mancuso
- Neuroradiology Unit and Neurology Unit, Ospedale Cisanello, Pisa, Italy (D.L.L., M. Mancuso)
| | - Elvis Lafe
- Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia, Italy (E.L.)
| | - Anna Cavallini
- Cerebrovascular Department, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini)
| | - Nicola Cavasin
- Neuroradiology Unit and Neurology Unit, Ospedale dell’Angelo-ULSS3 Serenissima, Mestre, Italy (N.C., A. Critelli)
| | - Adriana Critelli
- Neuroradiology Unit and Neurology Unit, Ospedale dell’Angelo-ULSS3 Serenissima, Mestre, Italy (N.C., A. Critelli)
| | - Elisa Francesca Maria Ciceri
- Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.)
| | - Bruno Bonetti
- Neuroscience Department, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., S.F., E.F.M.C., B.B.)
| | - Luigi Chiumarulo
- Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy (L. Chiumarulo, M. Petruzzelli)
| | - Marco Petruzzelli
- Interventional Neuroradiology Unit and Stroke Unit, Azienda Ospedaliera Universitaria-Policlinico, Bari, Italy (L. Chiumarulo, M. Petruzzelli)
| | - Andrea Giorgianni
- Neuroradiology Unit and Neurology Unit, Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy (A.G., M.V.)
| | - Maurizio Versino
- Neuroradiology Unit and Neurology Unit, Ospedale Universitario Circolo-ASST Sette Laghi, Varese, Italy (A.G., M.V.)
| | - Maria Porzia Ganimede
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy (M.P.G., A.T.)
| | - Angelica Tinelli
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale SS. Annunziata, Taranto, Italy (M.P.G., A.T.)
| | - Wiliam Auteri
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy (W.A., A.P.)
| | - Alfredo Petrone
- Interventional Neuroradiology Unit and Neurology Unit, Azienda Ospedaliera Annunziata, Cosenza, Italy (W.A., A.P.)
| | - Giulio Guidetti
- Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.)
| | - Ettore Nicolini
- Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.)
| | - Luca Allegretti
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.)
| | - Tiziana Tassinari
- Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure, Italy (V.S., L.A., T.T.)
| | - Pietro Filauri
- Interventional Neuroradiology Unit and Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy (P.F., S.S.)
| | - Simona Sacco
- Interventional Neuroradiology Unit and Stroke Unit, Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy (P.F., S.S.)
| | - Marco Pavia
- Neuroradiology Unit and Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (M. Pavia, P.I.)
| | - Paolo Invernizzi
- Neuroradiology Unit and Neurology Unit, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (M. Pavia, P.I.)
| | - Nunzio Paolo Nuzzi
- Interventional Neuroradiology Unit and Stroke Unit, Humanitas Research Hospital, Rozzano, Italy (N.P.N., M.C.S.)
| | - Maria Carmela Spinelli
- Interventional Neuroradiology Unit and Stroke Unit, Humanitas Research Hospital, Rozzano, Italy (N.P.N., M.C.S.)
| | - Pietro Amistà
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy (P.A., M. Russo)
| | - Monia Russo
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale S. Maria Misericordia, Rovigo, Italy (P.A., M. Russo)
| | - Delfina Ferrandi
- Neuroradiology Unit and Neurology Unit, AO SS. Antonio e Biagio e C. Arrigo, Alessandria, Italy (D.F.)
| | - Simona Corraine
- Interventional Vascular Unit and Stroke Unit, Ospedale S. Michele-AO Brotzu, Cagliari, Italy (S.C.)
| | - Giuseppe Craparo
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civico-A.R.N.A.S., Palermo, Italy (G. Craparo, M.M.)
| | - Marina Mannino
- Interventional Neuroradiology Unit and Stroke Unit, Ospedale Civico-A.R.N.A.S., Palermo, Italy (G. Craparo, M.M.)
| | - Luigi Simonetti
- Department of Neurology and Stroke Center, IRCCS Institute of the Neurological Sciences, Maggiore Hospital, Bologna, Italy (A.Z., L.S.)
| | - Danilo Toni
- Interventional Neuroradiology Unit and Stroke Unit, Sapienza University Hospital, Rome, Italy (G.G., E.N., D.T.)
| | - Salvatore Mangiafico
- NEUROFARBA Department, Careggi University Hospital, Firenze, Italy (S.N., P.N., S.M.)
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14
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Pedicelli A, Lozupone E, Valente I, Snider F, Rigante M, D'Argento F, Alexandre A, Garignano G, Chiumarulo L, Paludetti G, Colosimo C. Pre-operative direct puncture embolization of head and neck hypervascular tumors using SQUID 12. Interv Neuroradiol 2019; 26:346-353. [PMID: 31856645 DOI: 10.1177/1591019919895882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The authors have evaluated their experience in pre-operative direct puncture embolization of hypervascular tumors of the head and neck using SQUID 12, an embolic liquid agent. METHODS Between July 2016 and March 2019, the authors retrospectively reviewed clinical, embolization and surgical data of 11 consecutive patients with 12 hypervascular head and neck tumors who had undergone pre-operative embolization using SQUID 12. Percutaneous embolizations were performed by inserting a 19-22 Gauge needle directly into the tumor under ultrasound, fluoroscopic and/or endoscopic guidance. The hub of the needle was connected to a 15-cm DMSO-compatible extension tube, and the SQUID 12 was injected. RESULTS Total or near-total devascularization was achieved in 11 over 12 cases. Complete en-bloc tumor removal by surgery was achieved in all cases. Only one patient required blood transfusion. No major periprocedural adverse events were recorded. CONCLUSIONS Direct puncture embolization of hypervascular tumors of the head and neck using SQUID 12 seems to be safe and effective. It may offer almost complete devascularization due to homogenous, deep penetration in the tumor, with optimal visibility of the agent throughout the percutaneous procedure. It may reduce intraoperative blood loss and the need for transfusion, thus facilitating complete surgical resection.
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Affiliation(s)
- Alessandro Pedicelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia
| | - Emilio Lozupone
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia
| | - Iacopo Valente
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia
| | - Francesco Snider
- Dipartimento di Scienze Cardiovascolari e Toraciche, UOC Chirurgia Vascolare, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia.,Istituto di Patologia Speciale Chirurgica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Mario Rigante
- Dipartimento di Scienze Dell'invecchiamento, Neurologiche, Ortopediche e della Testa-collo, UOC Otorinolaringoiatria, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia
| | - Francesco D'Argento
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia
| | - Andrea Alexandre
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia
| | - Giuseppe Garignano
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Luigi Chiumarulo
- UOC Neuroradiologia, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, Italia
| | - Gaetano Paludetti
- Dipartimento di Scienze Dell'invecchiamento, Neurologiche, Ortopediche e della Testa-collo, UOC Otorinolaringoiatria, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia.,Istituto di Clinica Otorinolaringoiatrica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Cesare Colosimo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Roma, Italia.,Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia
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15
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Introna A, Mezzapesa DM, Petruzzellis M, Savarese M, Chiumarulo L, Zimatore DS, Dicuonzo F, Simone IL. Convexal subarachnoid hemorrhage and acute ischemic stroke: a border zone matter? Neurol Sci 2019; 40:1419-1424. [PMID: 30937557 DOI: 10.1007/s10072-019-03868-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 03/23/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Convexal subarachnoid hemorrhage (c-SAH) is an infrequent condition with variable causes. c-SAH concomitant to acute ischemic stroke (AIS) is even less frequent, and the relationship between the two conditions remains unclear. METHODS Between January 2016 and January 2018, we treated four patients who were referred to our stroke unit with ischemic stroke and concomitant nontraumatic c-SAH. The patients underwent an extensive diagnostic workup, including digital subtraction angiography (DSA). RESULTS All four patients developed acute focal neurological symptoms with restricted MRI diffusion in congruent areas. In three of the patients, infarcts were in a border zone between the main cerebral arteries and c-SAH was nearby. The fourth patient showed a small cortical infarct, and c-SAH was in a border zone territory of the contralateral hemisphere. An embolic source was discovered or strongly suspected in all cases. One patient was treated with intravenous thrombolysis, but this treatment was not related to c-SAH. None of the four patients showed microbleeds or further cortical siderosis, thus excluding cerebral amyloid angiopathy. In addition, DSA did not show signs of vasculitis, reversible cerebral vasoconstriction syndrome, or intracranial arterial dissection. CONCLUSIONS We proposed the embolism or hemodynamic changes of the border zone arterioles as a unifying pathogenetic hypothesis of coexisting c-SAH and AIS.
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Affiliation(s)
- Alessandro Introna
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy.
| | - Domenico Maria Mezzapesa
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Marco Petruzzellis
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Mariantonietta Savarese
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Luigi Chiumarulo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Domenico Sergio Zimatore
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Franca Dicuonzo
- Neuroradiology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Isabella Laura Simone
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
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16
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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 R, 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 ML, Lafe E, Denaro MF, Burdi N, Internò 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 EFM, 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 DS, 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 E, 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, Sanna A, 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. IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke. Stroke 2019; 50:909-916. [DOI: 10.1161/strokeaha.118.023316] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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.
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Affiliation(s)
- Manuel Cappellari
- Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Unit (S.M., S.N.), Ospedale Careggi-University Hospital, Firenze, Italy
| | - Valentina Saia
- Neurology and Stroke Unit (T.T., V.S.), Santa Corona Hospital, Pietra Ligure, Italy
| | - Giovanni Pracucci
- Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy
- University of Florence, Firenze, Italy (G.P., P.N., D.I.)
| | - Sergio Nappini
- Interventional Neuroradiology Unit (S.M., S.N.), Ospedale Careggi-University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy
- University of Florence, Firenze, Italy (G.P., P.N., D.I.)
| | - Daniel Konda
- Interventional Neuroradiology Unit (D.K.), Policlinico Tor Vergata, Roma, Italy
| | | | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy (S.V.)
| | - Andrea Zini
- Stroke Unit, IRCCS Istituto delle Scienze Neurologiche, Maggiore Hospital, Bologna, Italy (A.Z.)
| | - Sandra Bracco
- Interventional Neuroradiology Unit (S.B.), Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit (R.T.), Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit (M.B.), Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Stroke Unit (P.C.), Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Antonio Pitrone
- Interventional Neuroradiology Unit (A. Pitrone), Policlinico G. Martino, Messina, Italy
| | | | - Andrea Saletti
- Interventional Neuroradiology Unit (A.S.), Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Stroke Unit (A.D.V.), Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | - Mauro Magoni
- Stroke Unit (M. Magoni), Spedali Civili, Brescia, Italy
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit (E.P.), Ospedale Civile Mazzini, Teramo, Italy
| | | | - Francesco Causin
- Neuroradiology Unit (F.C.), Azienda Ospedaliero-Univeristaria, Padova, Italy
| | | | - Lucio Castellan
- Interventional Neuroradiology Unit (L. Castellan), IRCCS San Martino-IST, Genova, Italy
| | - Laura Malfatto
- Stroke Unit (L.M.), IRCCS San Martino-IST, Genova, Italy
| | - Roberto Menozzi
- Interventional Neuroradiology Unit (R.M.), Ospedale Universitario, Parma, Italy
| | | | - Chiara Comelli
- Interventional Neuroradiology Unit (C.C.), Ospedale San Giovanni Bosco, Torino, Italy
| | - Enrica Duc
- Neurology Unit (E.D.), Ospedale San Giovanni Bosco, Torino, Italy
| | - Alessio Comai
- Radiology Unit (A. Comai), Ospedale Centrale, Bolzano, Italy
| | | | - Mirco Cosottini
- Neuroradiology Unit (M. Cosottini), Ospedale Cisanello, Pisa, Italy
| | | | - Simone Peschillo
- Interventional Neuroradiology Unit (S.P.), Sapienza University Hospital, Roma, Italy
| | | | - Andrea Giorgianni
- Neuroradiology Unit (A.G.), Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy
| | | | - Elvis Lafe
- Diagnostic and Interventional Neuroradiology Unit (E.L.), San Matteo Hospital and C. Mondino Foundation, Pavia, Italy
| | | | - Nicola Burdi
- Interventional Radiology Unit (N.B.), Ospedale SS. Annunziata, Taranto, Italy
| | | | - Nicola Cavasin
- Neuroradiology Unit (N.C.), Ospedale dell’Angelo, USSL3 Serenissima, Mestre, Italy
| | - Adriana Critelli
- Neurology Unit (A. Critelli), Ospedale dell’Angelo, USSL3 Serenissima, Mestre, Italy
| | | | - Marco Petruzzellis
- Interventional Neuroradiology Unit (M. Petruzzellis), Policlinico, Bari, Italy
| | - Marco Doddi
- Interventional Neuroradiology Unit (M.D.), Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Antonio Carolei
- Stroke Unit (A. Carolei), Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - William Auteri
- Interventional Neuroradiology Unit (W.A.), Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Alfredo Petrone
- Neurology Unit (A. Petrone), Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | - Tiziana Tassinari
- Neurology and Stroke Unit (T.T., V.S.), Santa Corona Hospital, Pietra Ligure, Italy
| | - Marco Pavia
- Interventional Neuroradiology Unit (M. Pavia), Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Invernizzi
- Stroke Unit (P.I.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Gianni Turcato
- Emergency Department, Girolamo Fracastoro Hospital, San Bonifacio (Verona), Italy (G.T.)
| | - Stefano Forlivesi
- Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Bruno Bonetti
- Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Domenico Inzitari
- Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy
- University of Florence, Firenze, Italy (G.P., P.N., D.I.)
| | - Danilo Toni
- Stroke Unit (M.D.M., D.T.), Sapienza University Hospital, Roma, Italy
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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 R, 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, Luisa Delodovici M, Lafe E, Denaro MF, Burdi N, Internò 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, Francesca Maria Ciceri E, Bonetti B, Inzitari D, Toni D. IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke. Int J Stroke 2019; 15:412-420. [PMID: 30907302 DOI: 10.1177/1747493019837756] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance. AIMS We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset. METHODS We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3-6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training (n = 1219) and test (n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816-0.869) in the training set, and 0.820 (95% CI: 0.786-0.854) in the test set. CONCLUSIONS The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Stefano Vallone
- Ospedale Civile S. Agostino-Estense - University Hospital, Modena, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche, Maggiore Hospital, Bologna, Italy
| | - Sandra Bracco
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Mauro Bergui
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Enrica Duc
- Ospedale San Giovanni Bosco, Torino, Italy
| | | | | | | | | | | | | | | | | | - Elvis Lafe
- San Matteo Hospital & C. Mondino Foundation, Pavia, Italy
| | | | | | | | | | | | | | | | - Marco Doddi
- Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | | | | | | | | | | | - Marco Pavia
- Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | | | - Gianni Turcato
- Girolamo Fracastoro Hospital, San Bonifacio (Verona), Italy
| | | | | | - Bruno Bonetti
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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18
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Introna A, Chiumarulo L, Petruzzellis M. Dissecating aneurysm of extracranial internal carotid artery presenting with Tapia syndrome in patient with essential thrombocythemia. Neurol Sci 2017; 38:1893-1895. [PMID: 28601975 DOI: 10.1007/s10072-017-3017-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Alessandro Introna
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy.
| | - Luigi Chiumarulo
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
| | - Marco Petruzzellis
- Neurology Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari 'Aldo Moro', Piazza Giulio Cesare 11, 70100, Bari, Italy
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19
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Favia G, Salvati A, Chiumarulo L, Dicuonzo F. Intervertebral disc calcification in childhood: Case report and review of relevant literature. J Craniovertebr Junction Spine 2015; 6:97-8. [PMID: 25972719 PMCID: PMC4426532 DOI: 10.4103/0974-8237.156074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - Andrea Salvati
- Department of Neuroimaging, Hospital Policlinico, Bari, Italy
| | | | - Franca Dicuonzo
- Department of Neuroimaging, Hospital Policlinico, Bari, Italy
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20
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Giordano P, Lenato GM, Suppressa P, Lastella P, Dicuonzo F, Chiumarulo L, Sangerardi M, Piccarreta P, Valerio R, Scardapane A, Marano G, Resta N, Quaranta N, Sabbà C. Hereditary hemorrhagic telangiectasia: arteriovenous malformations in children. J Pediatr 2013; 163:179-86.e1-3. [PMID: 23535011 DOI: 10.1016/j.jpeds.2013.02.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/27/2012] [Accepted: 02/06/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the clinical features in a large cohort of pediatric patients with genetically confirmed hereditary hemorrhagic telangiectasia (HHT) and to identify possible predictors of arteriovenous malformation (AVM) onset or clinical significance. STUDY DESIGN Prospective cross-sectional survey of all children subjected to screening for AVMs in the multidisciplinary HHT center. All patients proved to be carriers of endoglin mutations or activin A receptor type-II-like kinase 1 mutations, defined as HHT1 and HHT2, respectively. A full clinical-radiological protocol for AVM detection was adopted, independent from presence or absence of AVM-related symptoms. RESULTS Forty-four children (mean age, 10.3 years; range, 1-18) were subjected to a comprehensive clinical-radiologic evaluation. This investigation disclosed cerebrovascular malformations in 7 of 44 cases, pulmonary AVMs in 20 of 44 cases, and liver AVMs in 23 of 44 cases. Large visceral AVMs were found in 12 of 44 children and were significantly more frequent in patients with HHT1. Only large AVMs were associated with symptoms and complications. CONCLUSIONS Children with HHT have a high prevalence of AVMs; therefore, an appropriate clinical and radiological screening protocol is advisable. Large AVMs can be associated with complications in childhood, whereas small AVMs probably have no clinical risk.
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Affiliation(s)
- Paola Giordano
- Pediatric Unit, Interdisciplinary Department of Medicine, University Hospital of Bari, Bari, Italy
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21
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Abud TG, Nguyen A, Saint-Maurice JP, Abud DG, Bresson D, Chiumarulo L, Enesi E, Houdart E. The use of Onyx in different types of intracranial dural arteriovenous fistula. AJNR Am J Neuroradiol 2011; 32:2185-91. [PMID: 21960490 DOI: 10.3174/ajnr.a2702] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recently some series have been published about the use of Onyx for the treatment of DAFVs with satisfactory results. Our aim was to describe the treatment of different types of intracranial DAVFs with transcatheter injection of Onyx through an arterial approach. MATERIALS AND METHODS At the Department of Interventional Neuroradiology, Hospital Lariboisière Paris, between January 2005 and January 2010, we treated 44 DAVFs in 42 patients. All patients were initially treated by arterial injection of Onyx. The average patient age was 56 years (range, 27-86 years), and there were 17 women and 25 men treated. RESULTS A total of 58 arterial pedicles were catheterized, with the middle meningeal artery representing the most common site (n = 38). The average time of injection was 30 minutes (range, 15-60 minutes), and the average amount of Onyx was 2.5 mL (range, 0.6-6.5 mL). Of the 20 fistulas with direct venous drainage into a dural sinus (types I and II), we achieved the preservation of the sinus in 7 patients. Of the 44 fistulas embolized, 8 required a second embolization treatment and 1 fistula required a third treatment. In 9 cases, a complementary treatment was performed via transvenous embolization with coils and/or open surgery. Early complications were observed in 6 patients: Four had nerve injury (facial palsy, n = 2, and neuralgia, n = 2), and 2 had complications related to extension of venous thrombosis postembolization. All 6 patients had partial or complete resolution of these symptoms. CONCLUSIONS The treatment of DAVFs by intracranial arterial injection of Onyx is safe, and, in most cases, results in the occlusion of the arterial venous shunt. In DAVFs with direct sinus drainage, sinus preservation was only possible in 7 of 20 patients (35%).
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Affiliation(s)
- T G Abud
- Service de Neuroradiologie Diagnostique et Interventionnelle, Hopital Lariboisière, Paris, France
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22
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Salvati A, Ferrari C, Chiumarulo L, Medicamento N, Dicuonzo F, De Blasi R. Endovascular treatment of brain arteriovenous malformations ruptured during pregnancy--a report of two cases. J Neurol Sci 2011; 308:158-61. [PMID: 21719029 DOI: 10.1016/j.jns.2011.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 06/07/2011] [Indexed: 11/20/2022]
Abstract
Acutely ruptured brain arteriovenous malformations (AVMs) are a known etiology of hemorrhagic stroke during pregnancy. The aim of this paper is to report two cases of patients which presented with ruptured AVMs during pregnancy and were successfully treated with endovascular techniques. Peculiar issues related to the application of this treatment strategy in this category of patients will be discussed as well. To the best of our knowledge, this therapeutic approach in cerebral AVMs ruptured during pregnancy has not been described yet.
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Affiliation(s)
- Andrea Salvati
- Department of Neurological and Psychiatric Sciences, Neuroradiology Unit, University of Bari, Italy.
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23
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De Blasi R, Bracciolini E, Chiumarulo L, Salvati A, Monetti C, Federico F, Carella A. Pseudoaneurysm formation following intrasphenoid rupture of an idiopathic intracavernous carotid artery aneurysm: coil migration and early recurrence after endovascular treatment. Interv Neuroradiol 2010; 16:442-6. [PMID: 21162775 DOI: 10.1177/159101991001600411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2010] [Accepted: 09/04/2010] [Indexed: 11/15/2022] Open
Abstract
Intrasphenoid rupture of a non-traumatic aneurysm of the cavernous carotid artery is rare. We describe a patient in whom this condition manifested with epistaxis and led to the formation of a pseudoaneurysm occupying the right sphenoid sinus. The lesion recurred after repeated attempts at conservative endovascular therapy. Eventually the patient was treated with endovascular occlusion of the right internal carotid artery. Our report emphasizes the relapsing behaviour of a non-traumatic aneurysm of the cavernous portion of the internal carotid artery ruptured into the sphenoid sinus.
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Affiliation(s)
- R De Blasi
- Unit of Neuroradiology and Interventional Radiology, "Di Venere" Hospital, Bari, Italy
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24
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De Blasi R, Salvati A, Medicamento N, Chiumarulo L. Clinical Features and Classification of Brain AVMs and Cranial DAVFs. Neuroradiol J 2009; 22:568-80. [DOI: 10.1177/197140090902200510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 10/19/2009] [Indexed: 11/16/2022] Open
Abstract
The clinical findings of intracranial vascular malformations are strictly related to their morphologic, angioarchitectural and hemodynamic characteristics. An overall study of these features is the first step to understand the different classifications for arteriovenous malformations, dural arteriovenous fistulas and carotid-cavernous fistulas. This evaluation will also suggest the correct timing of endovascular treatment and which part of the lesion should be the target of the therapy. Conventional cerebral angiography is mandatory when a correct classification of intracranial arteriovenous malformative shunts must be achieved. The angioarchitectural classification of brain arteriovenous malformations considers all angiographic features of each component of the malformation, both morphologically and hemodynamically, and relates them to the clinical course of the disease. The correlation between clinical findings, angiographic features and classifications is even stronger for cranial dural arteriovenous fistulas, in which cortical venous drainage is typical of “aggressive” fistulas and is usually absent in the “benign” type. Similarly, carotid-cavernous fistulas can be differentiated at angiography into high or low flow lesions according to the flow rate of the shunt, and into direct or indirect fistulas, according to the origin of arterial feeders. This paper focuses on the existing relation between the hemodynamics of brain arteriovenous malformations, cranial dural arteriovenous fistulas, carotid-cavernous fistulas, and their most frequent clinical findings, through an analysis of the most widely used different classification systems.
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Affiliation(s)
- R. De Blasi
- Department of Neuroradiology, Bari University Hospital; Bari, Italy
| | - A. Salvati
- Department of Neuroradiology, Bari University Hospital; Bari, Italy
| | - N. Medicamento
- Department of Neuroradiology, Bari University Hospital; Bari, Italy
| | - L. Chiumarulo
- Department of Neuroradiology, Bari University Hospital; Bari, Italy
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25
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Liguori M, Mazzei R, Ungaro C, Simone IL, Gambardella A, Plasmati I, Fera F, Aguglia U, Lanza P, Bono F, Chiumarulo L, Conforti FL, Consoli D, Quattrone A. CONVENTIONAL MRI AND NOTCH3 GENE SCREENING IN SPORADIC CADASIL. Neurology 2008; 72:469-71. [DOI: 10.1212/01.wnl.0000336342.04778.2b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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26
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Stabile Ianora AA, Midiri M, Chiumarulo L, Scardapane A, Strada A, Angelelli G, Rotondo A. Helical CT: a useful technique in the evaluation of aortic intramural hematoma. Emerg Radiol 2001. [DOI: 10.1007/pl00011932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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