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Romani I, Sarti C, Nencini P, Pracucci G, Zedde M, Cianci V, Nucera A, Moller J, Orsucci D, Toni D, Palumbo P, Casella C, Pinto V, Barbarini L, Bella R, Scoditti U, Ragno M, Mezzapesa DM, Tassi R, Volpi G, Diomedi M, Bigliardi G, Cavallini AM, Chiti A, Ricci S, Cecconi E, Linoli G, Sacco S, Rasura M, Giordano A, Bonetti B, Melis M, Cariddi LP, Dossi RC, Grisendi I, Aguglia U, Di Ruzza MR, Melis M, Sbardella E, Vista M, Valenti R, Musolino RF, Passarella B, Direnzo V, Pennisi G, Genovese A, Di Marzio F, Sgobio R, Acampa M, Nannucci S, Dagostino F, Dell'Acqua ML, Cuzzoni MG, Picchioni A, Calchetti B, Notturno F, Di Lisi F, Forlivesi S, Delodovici ML, Buechner SC, Biagini S, Accavone D, Manna R, Morrone A, Inzitari D. Prevalence of Fabry disease and GLA variants in young patients with acute stroke: The challenge to widen the screening. The Fabry-Stroke Italian Registry. J Neurol Sci 2024; 457:122905. [PMID: 38295534 DOI: 10.1016/j.jns.2024.122905] [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: 09/12/2023] [Revised: 12/10/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Fabry disease (FD) is a treatable X-linked lysosomal storage disorder caused by GLA gene variants leading to alpha-galactosidase A deficiency. FD is a rare cause of stroke, and it is still controversial whether in stroke patients FD should be searched from the beginning or at the end of the diagnostic workup (in cryptogenic strokes). METHODS Fabry-Stroke Italian Registry is a prospective, multicentric screening involving 33 stroke units. FD was sought by measuring α-galactosidase A activity (males) and by genetic tests (males with reduced enzyme activity and females) in patients aged 18-60 years hospitalized for TIA, ischemic stroke, or intracerebral hemorrhage. We diagnosed FD in patients with 1) already known pathogenic GLA variants; 2) novel GLA variants if additional clinical, laboratory, or family-derived criteria were present. RESULTS Out of 1906 patients, we found a GLA variant in 15 (0.79%; 95%CI 0.44-1.29) with a certain FD diagnosis in 3 (0.16%; 95%CI 0.03-0.46) patients, none of whom had hemorrhage. We identified 1 novel pathogenic GLA variant. Ischemic stroke etiologies in carriers of GLA variants were: cardioaortic embolism (33%), small artery occlusion (27%), other causes (20%), and undetermined (20%). Mild severity, recurrence, previous TIA, acroparesthesias, hearing loss, and small artery occlusion were predictors of GLA variant. CONCLUSION In this large multicenter cohort the frequency of FD and GLA variants was consistent with previous reports. Limiting the screening for GLA variants to patients with cryptogenic stroke may miss up to 80% of diagnoses. Some easily recognizable clinical features could help select patients for FD screening.
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Affiliation(s)
- Ilaria Romani
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Cristina Sarti
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy.
| | - Patrizia Nencini
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Giovanni Pracucci
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Vittoria Cianci
- Neurology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Antonia Nucera
- Stroke Unit - Neurology, Spaziani Hospital, Frosinone, Italy
| | | | | | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; Emergency Department Stroke Unit, Umberto I Polyclinic Hospital, Rome, Italy
| | - Pasquale Palumbo
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | - Carmela Casella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Vincenza Pinto
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | | | - Rita Bella
- Acute Cerebrovascular Diseases Unit, G. Rodoloco-San Marco Polyclinic University Hospital, Catania, Italy; Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Italy
| | - Umberto Scoditti
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | - Michele Ragno
- Division of Neurology, ASUR Marche AV5, Ascoli Piceno-San Benedetto del Tronto, Italy
| | | | - Rossana Tassi
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | - Gino Volpi
- Neurology, San Iacopo Hospital, Pistoia, Italy
| | - Marina Diomedi
- Comprehensive Stroke Center, Department of Neuroscience, University of Tor Vergata, Rome, Italy; Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Guido Bigliardi
- Stroke Unit, Neurology Clinic, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Anna Maria Cavallini
- Department of Cerebrovascular Disease and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Stefano Ricci
- Stroke Center - Neurology, Città Di Castello Hospital, Perugia, Italy; Stroke Center - Neurology, Gubbio-Gualdo Tadino Hospital, Perugia, Italy
| | | | | | - Simona Sacco
- Neurology and Stroke Unit, SS. Filippo e Nicola Hospital, Avezzano, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Maurizia Rasura
- Stroke Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Bruno Bonetti
- Stroke Unit, Verona University Hospital, Verona, Italy
| | - Marta Melis
- Neurology, Monserrato University Hospital, Cagliari, Italy
| | | | | | - Ilaria Grisendi
- Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Umberto Aguglia
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | | | - Emilia Sbardella
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Raffaella Valenti
- Neurology, Neurophysiopathology, and Stroke Unit, Santo Stefano Hospital, Prato, Italy
| | | | - Bruno Passarella
- Neurology and Stroke Unit, Di Summa - Perrino Hospital, Brindisi, Italy
| | | | - Giovanni Pennisi
- Acute Cerebrovascular Diseases Unit, G. Rodoloco-San Marco Polyclinic University Hospital, Catania, Italy; Department of Biomedical and Biotechnological Science, University of Catania, Catania, Italy
| | - Antonio Genovese
- Neurology - Stroke Care Program, Parma University Hospital, Parma, Italy
| | - Fabio Di Marzio
- Division of Neurology, ASUR Marche AV5, Ascoli Piceno-San Benedetto del Tronto, Italy
| | - Rossana Sgobio
- University Neurology, Bari Polyclinic Hospital, Bari, Italy
| | - Maurizio Acampa
- Neurosonology and Stroke Unit, Siena University Hospital, Siena, Italy
| | | | - Federica Dagostino
- Neurovascular Treatment Unit, Tor Vergata Polyclinic Hospital, Rome, Italy
| | - Maria Luisa Dell'Acqua
- Stroke Unit, Neurology Clinic, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy
| | - Maria Giovanna Cuzzoni
- Department of Cerebrovascular Disease and Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonella Picchioni
- Stroke Center - Neurology, Città Di Castello Hospital, Perugia, Italy; Stroke Center - Neurology, Gubbio-Gualdo Tadino Hospital, Perugia, Italy
| | | | - Francesca Notturno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Filomena Di Lisi
- Stroke Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Silvia Biagini
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Donatella Accavone
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy
| | - Raffaele Manna
- Department of Internal Medicine, Gemelli University Hospital, Rome, Italy; Rare Diseases and Periodic Fevers Research Centre, Catholic University of the Sacred Heart, Rome, Italy
| | - Amelia Morrone
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Laboratory of Molecular Biology of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, Florence, Italy
| | - Domenico Inzitari
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Italy; Stroke Unit, Careggi University Hospital, Florence, Italy
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Ciacciarelli A, Tessitore A, Fiume G, Currò CT, Coglitore A, Gardin A, Giammello F, Grillo F, Longo M, Mormina E, Vecchio CF, Vicari D, Musolino RF, Toscano A, Vinci SL, La Spina P. Factors associated with hemorrhagic transformation after endovascular treatment despite early recanalization. J Neurol Sci 2023; 453:120778. [PMID: 37669577 DOI: 10.1016/j.jns.2023.120778] [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: 03/23/2023] [Revised: 07/24/2023] [Accepted: 08/27/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE To identify new factors associated with hemorrhagic transformation (HT) despite early recanalization in patients with acute ischemic stroke treated with mechanical thrombectomy. METHODS We retrospectively included patients with known onset of large vessel occlusion treated with mechanical thrombectomy +/- intravenous thrombolysis. Non-contrast CT was performed at 24 +/- 12 h from endovascular procedure. We collected data on patient characteristics, risk factors, radiological and treatment features, stroke severity on admission and discharge, carotid intima-media thickness (CIMT), Neutrophils-to-Lymphocytes ratio (NLR), white matter hyperintensities measured according to the Fazekas score on FLAIR MRI data. The main outcome measures were the incidence of HT and factors associated with it. Secondary outcome measures were symptomatic intracerebral hemorrhage and parenchymal hematoma. RESULTS Of 874 patients, 472 met the inclusion criteria, 211 (44.7%) had HT. Factors significantly associated with increased risk of HT included onset-to-recanalization time, CIMT (normal/mild), ASPECT-MRI < 6, and a higher NLR. We found that beyond 7.67 h from onset-to-recanalization, the risk of HT increases and exceeds 50%. ASPECT-MRI, NLR, and CIMT independently predict HT despite early recanalization. CONCLUSIONS We identified novel factors associated with HT in patients with acute ischemic stroke of known onset treated with mechanical thrombectomy. We found that at 7.67 h from onset to recanalization, the risk of HT is >50%, and we identified factors responsible for HT despite early recanalization.
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Affiliation(s)
- Antonio Ciacciarelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy; U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giulia Fiume
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Alessandra Coglitore
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Anna Gardin
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Grillo
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Mirta Longo
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Enrico Mormina
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Concetto Fabio Vecchio
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Davide Vicari
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Antonio Toscano
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy.
| | - Paolino La Spina
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
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3
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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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Ciacciarelli A, Francalanza I, Giammello F, Galletta K, Toscano A, Musolino RF, Granata F, La Spina P. Prevalence, clinical features, and radiological pattern of artery of Percheron infarction: a challenging diagnosis. Neurol Sci 2023:10.1007/s10072-023-06681-4. [PMID: 36800102 DOI: 10.1007/s10072-023-06681-4] [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: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE Occlusion of artery of Percheron (AOP), a rare variant of paramedian branches of posterior cerebral artery, results in a characteristic pattern of ischemic lesions in bilateral paramedian thalami with or without midbrain and anterior thalami involvement. AIM To evaluate the prevalence, the clinical, and the imaging features of AOP infarction in a single comprehensive stroke center experience. METHODS We retrospectively search in our stroke center database, patients with ischemic lesions in the AOP distribution. We collected clinical features and time between hospital admission and diagnosis. Imaging findings were categorized following a pre-selected classification. RESULTS Of 2830 ischemic stroke admitted in our center, we identified 15 patients with AOP infarction (0.53%). Clinical manifestations were variable, but oculomotor disturbances, particularly vertical gaze palsy, were the most observed, followed by consciousness impairment, varying from drowsiness to coma. The most frequent imaging pattern was bilateral paramedian thalamic infarction with midbrain infarction, and the V-sign was recognized in 6 cases from this group. In 8 patients a fetal origin of the PCA was observed. The average time from first hospital admission to diagnosis was 28.09 h. CONCLUSIONS The prevalence of AOP infarction in our center was 0.53%. Diagnosis of AOP infarction can be challenging and should be suspected in case of sudden altered consciousness.
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Affiliation(s)
- Antonio Ciacciarelli
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Isabella Francalanza
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Karol Galletta
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Toscano
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Rosa Fortunata Musolino
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Francesca Granata
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Paolino La Spina
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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5
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Romoli M, Matteo E, Migliaccio L, Gentile M, Mosconi MG, Scura GM, Naccarato M, Colangeli E, Candelaresi P, Andreone V, Giammello F, Fortunata Musolino R, Dell’Aera C, Sepe FN, Pronello E, Barbarini L, Caggiula M, Rizzo F, Petruzzellis M, Giorli E, Zedde ML, Anticoli S, Mangiardi M, Muto M, Diana F, De Angelis MV, Digiovanni A, Concari L, La Gioia S, Sessa M, Biguzzi S, Cordici F, Longoni M, Ruggiero M, Cenciarelli S, Eusebi P, Sacco S, Caso V, Paciaroni M, Ricci S, Zini A, Toni D, Giannandrea D. Thrombolysis after dabigatran reversal: A nation-wide Italian multicentre study, systematic review and meta-analysis. Eur Stroke J 2022; 8:117-124. [PMID: 37021155 PMCID: PMC10069212 DOI: 10.1177/23969873221131635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Recent anticoagulant intake represents a contraindication for thrombolysis in acute ischemic stroke. Idarucizumab reverses the anticoagulant effect of dabigatran, potentially allowing for thrombolysis. This nation-wide observational cohort study, systematic review, and meta-analysis evaluated the efficacy and safety of thrombolysis preceded by dabigatran-reversal in people with acute ischemic stroke. Patients and methods: We recruited people undergoing thrombolysis following dabigatran-reversal at 17 stroke centers in Italy (reversal-group), people on dabigatran treated with thrombolysis without reversal (no-reversal group), and age, sex, hypertension, stroke severity, and reperfusion treatment-matched controls in 1:7 ratio (control-group). We compared groups for symptomatic intracranial hemorrhage (sICH, main outcome), any brain hemorrhage, good functional outcome (mRS 0–2 at 3 months), and death. The systematic review followed a predefined protocol (CRD42017060274), and odds ratio (OR) meta-analysis was implemented to compare groups. Results: Thirty-nine patients in dabigatran-reversal group and 300 matched controls were included. Reversal was associated with a non-significant increase in sICH (10.3% vs 6%, aOR = 1.32, 95% CI = 0.39–4.52), death (17.9% vs 10%, aOR = 0.77, 95% CI = 0.12–4.93) and good functional outcome (64.1% vs 52.8%, aOR = 1.41, 95% CI = 0.63–3.19). No hemorrhagic events or deaths were registered in no-reversal group (n = 12). Pooling data from 3 studies after systematic review (n = 1879), reversal carried a non-significant trend for sICH (OR = 1.53, 95% CI = 0.67–3.50), death (OR = 1.53, 95% CI = 0.73–3.24) and good functional outcome (OR = 2.46, 95% CI = 0.85–7.16). Discussion and conclusion: People treated with reperfusion strategies after dabigatran reversal with idarucizumab seem to have a marginal increase in the risk of sICH but comparable functional recovery to matched patients with stroke. Further studies are needed to define treatment cost-effectiveness and potential thresholds in plasma dabigatran concentration for reversal.
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Affiliation(s)
- Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Eleonora Matteo
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Ludovica Migliaccio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Bologna, Italy
| | - Mauro Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Bologna, Italy
| | - Maria Giulia Mosconi
- Medicina Vascolare e d’Urgenza, Stroke Unit, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Perugia, Italy
| | - Giuseppe Maria Scura
- Medicina Vascolare e d’Urgenza, Stroke Unit, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Perugia, Italy
| | - Marcello Naccarato
- Neurology and Stroke Unit, Department of Medical, Surgical and Health Sciences, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Enrico Colangeli
- University of L’Aquila, Department of Biotechnological and Applied Clinical Sciences, L’Aquila, Italy
| | - Paolo Candelaresi
- UOC Neurologia e Stroke Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italy
| | - Vincenzo Andreone
- UOC Neurologia e Stroke Unit, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italy
| | - Fabrizio Giammello
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Dell’Aera
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Edoardo Pronello
- Stroke Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | - Federica Rizzo
- UOC Neurologia e Stroke Unit “F. Puca” AOU Consorziale Policlinico Bari, Bari, Italy
| | - Marco Petruzzellis
- UOC Neurologia e Stroke Unit “F. Puca” AOU Consorziale Policlinico Bari, Bari, Italy
| | - Elisa Giorli
- SC Neurologia, Ospedale S. Andrea, La Spezia, Italy
| | - Maria Luisa Zedde
- S.C Neurologia, Stroke Unit, Azienda USL, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Sabrina Anticoli
- Stroke Unit, Head, Neck and Neuroscience Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Marilena Mangiardi
- Stroke Unit, Head, Neck and Neuroscience Department, San Camillo Forlanini Hospital, Rome, Italy
| | - Mario Muto
- UOC Neuroradiologia diagnostica ed interventistica, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, Napoli, Italy
| | - Francesco Diana
- Neuroradioly, University Hospital San Giovanni di Dio e Ruggi D’Aragona, Salerno, Italy
| | | | - Anna Digiovanni
- Department of Neurology, SS Annunziata Hospital, Chieti, Italy
| | - Letizia Concari
- SC Neurologia, Azienda Ospedaliera Universitaria di Parma, Parma, Italy
| | - Sara La Gioia
- UOC Neurologia, Stroke Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Sessa
- UOC Neurologia, Stroke Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Biguzzi
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Francesco Cordici
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Marco Longoni
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | | | - Silvia Cenciarelli
- Neurologia e Stroke Unit, Ospedale di Gubbio e Città di Castello, USL Umbria 1, Perugia, Italy
| | - Paolo Eusebi
- Umbria Regional Health Authority, Perugia, Italy
| | - Simona Sacco
- University of L’Aquila, Department of Biotechnological and Applied Clinical Sciences, L’Aquila, Italy
| | - Valeria Caso
- Medicina Vascolare e d’Urgenza, Stroke Unit, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Perugia, Italy
| | - Maurizio Paciaroni
- Medicina Vascolare e d’Urgenza, Stroke Unit, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia, Perugia, Italy
| | - Stefano Ricci
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), Università di Bologna, Bologna, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurologia e Rete Stroke Metropolitana, Bologna, Italy
| | - Danilo Toni
- Stroke Unit, Emergency Department, Sapienza University of Rome, Roma, Italy
| | - David Giannandrea
- Neurologia e Stroke Unit, Ospedale di Gubbio e Città di Castello, USL Umbria 1, Perugia, Italy
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6
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Vetta G, Parlavecchio A, Caminiti R, Crea P, Magnocavallo M, Della Rocca DG, Lavalle C, Vetta F, Marano G, Ruggieri C, Lofrumento F, Dattilo G, Ferraù L, Dell'Aera C, Giammello F, La Spina P, Musolino RF, Luzza F, Carerj S, Micari A, Di Bella G. Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke. J Electrocardiol 2022; 74:46-53. [PMID: 35964522 DOI: 10.1016/j.jelectrocard.2022.07.071] [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: 05/01/2022] [Revised: 07/06/2022] [Accepted: 07/23/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended. OBJECTIVE To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG. METHODS We prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF. RESULTS Among 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68-0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8-32.8; p < 0.0001). CONCLUSIONS NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
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Affiliation(s)
- Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | | | - Giovanni Marano
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Chiara Ruggieri
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Lofrumento
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Luzza
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Scipione Carerj
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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7
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Romoli M, Vandelli L, Bigliardi G, Naccarato M, Moller J, Balestrino M, Giammello F, Gentile M, Dell'Acqua ML, Manganotti P, Forlivesi S, Melis M, Picchetto L, Rosafio F, Furlanis G, Testoni S, Piras V, Malfatto L, Musolino RF, Scali I, Maffei S, Migliaccio L, Trenti T, Mancini R, Marietta M, Randi V, Meletti S, Zini A. Fibrinogen Depletion Coagulopathy Predicts Major Bleeding After Thrombolysis for Ischemic Stroke: A Multicenter Study. Stroke 2022; 53:3671-3678. [PMID: 36039754 DOI: 10.1161/strokeaha.122.039652] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Symptomatic intracerebral hemorrhage (sICH) and major bleeding can be fatal complications of intravenous thrombolysis (IVT) for acute ischemic stroke. We investigated the impact of early fibrinogen depletion after IVT on major bleeding events. METHODS This multicenter observational prospective cohort study enrolled 1678 consecutive patients receiving IVT for acute ischemic stroke at 6 Italian centers, undergoing fibrinogen concentration assessment at baseline, 2 hours and 6 hours after IVT. Fibrinogen depletion was defined as a reduction below 200 mg/dL after 2 hours from IVT, or as a reduction below 50% of baseline fibrinogen levels after 2 hours from IVT. Main outcomes were (1) sICH (National Institute of Neurological Disorders and Stroke criteria) and (2) major bleeding defined as fatal bleeding, decrease in the hemoglobin level>2 g/dL/>1 unit transfusion, or bleeding at critical site. Additional outcomes were (1) any ICH, (2) any bleeding, (3) fatal ICH, and (4) sICH according to ECASSII definition. Good functional recovery was defined as modified Rankin Scale score 0 to 2 at 3 months. RESULTS Overall, 1678 patients were included (mean age 72 years, 46% female). sICH (n=116) and major bleeding (n=297) were associated with lower rate of good functional recovery (P<0.001). Despite similar fibrinogen levels at admission, fibrinogen depletion after 2 hours from IVT was more common in people with sICH, major bleeding and all additional bleeding outcomes. In the backward stepwise multivariable logistic regression model, fibrinogen depletion remained a significant predictor of sICH (OR, 1.55 [95% CI, 1.04-2.32]) and major bleeding (OR, 1.36 [95% CI, 1.03-1.8]). Thirty-one percent of sICH could be attributable to fibrinogen depletion. The association between fibrinogen depletion and worse clinical outcome at 3 months after stroke (P=0.012) was attributable to the higher risk of major bleeding/sICH. CONCLUSIONS Fibrinogen depletion significantly increases the risk of sICH and major bleeding after IVT for acute ischemic stroke. Fibrinogen depletion represents an independent risk factor for bleeding, and routine assessment could be considered to stratify the risk of ICH. Trials on early fibrinogen repletion are needed to investigate mitigation of bleeding risk.
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Affiliation(s)
- Michele Romoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Italy (M.R., M.G., S.F., S.T., L.M., A.Z.).,Neurology and Stroke Unit' Bufalini Hospital' Cesena' Italy (M.R.)
| | - Laura Vandelli
- Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliera Universitaria di Modena, Italy (L.V., G.B., M.L.D., L.P., F.R., S. Maffei, S. Meletti)
| | - Guido Bigliardi
- Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliera Universitaria di Modena, Italy (L.V., G.B., M.L.D., L.P., F.R., S. Maffei, S. Meletti)
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Italy (M.N., P.M., G.F., I.S.)
| | - Jessica Moller
- Neurology and Stroke Unit, Neuroscience and Rehabilitation Department, Azienda Ospedaliera G Brotzu, Cagliari, Italy (J.M., M.M., V.P.)
| | - Maurizio Balestrino
- IRCCS Ospedale Policlinico San Martino, Genova, Italy (M.B., L.M.).,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences (DINOGMI), University of Genoa, Italy (M.B.)
| | - Fabrizio Giammello
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino (F.G., R.F.M.), University of Messina, Italy.,International PhD in Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images (F.G.), University of Messina, Italy
| | - Mauro Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Italy (M.R., M.G., S.F., S.T., L.M., A.Z.)
| | - Maria Luisa Dell'Acqua
- Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliera Universitaria di Modena, Italy (L.V., G.B., M.L.D., L.P., F.R., S. Maffei, S. Meletti)
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Italy (M.N., P.M., G.F., I.S.)
| | - Stefano Forlivesi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Italy (M.R., M.G., S.F., S.T., L.M., A.Z.)
| | - Maurizio Melis
- Neurology and Stroke Unit, Neuroscience and Rehabilitation Department, Azienda Ospedaliera G Brotzu, Cagliari, Italy (J.M., M.M., V.P.)
| | - Livio Picchetto
- Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliera Universitaria di Modena, Italy (L.V., G.B., M.L.D., L.P., F.R., S. Maffei, S. Meletti)
| | - Francesca Rosafio
- Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliera Universitaria di Modena, Italy (L.V., G.B., M.L.D., L.P., F.R., S. Maffei, S. Meletti)
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Italy (M.N., P.M., G.F., I.S.)
| | - Stefania Testoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Italy (M.R., M.G., S.F., S.T., L.M., A.Z.)
| | - Valeria Piras
- Neurology and Stroke Unit, Neuroscience and Rehabilitation Department, Azienda Ospedaliera G Brotzu, Cagliari, Italy (J.M., M.M., V.P.)
| | - Laura Malfatto
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Italy (M.R., M.G., S.F., S.T., L.M., A.Z.)
| | - Rosa Fortunata Musolino
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino (F.G., R.F.M.), University of Messina, Italy
| | - Ilario Scali
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Italy (M.N., P.M., G.F., I.S.)
| | - Stefania Maffei
- Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliera Universitaria di Modena, Italy (L.V., G.B., M.L.D., L.P., F.R., S. Maffei, S. Meletti)
| | | | - Tommaso Trenti
- Dipartimento di Medicina di Laboratorio e Anatomia Patologica Azienda Ospedaliera Universitaria e USL di Modena, Italy (T.T.)
| | - Rita Mancini
- Department of Oncology and Haematology, Azienda Ospedaliera Universitaria di Modena, Italy (R.M.)
| | - Marco Marietta
- Laboratorio Unico Metropolitano, AUSL Bologna, Italy (M.M.)
| | - Vanda Randi
- Regional Blood Centre of Emilia-Romagna, Maggiore Hospital, AUSL Bologna, Italy (V.R.)
| | - Stefano Meletti
- Stroke Unit - Neurology Clinic, Department of Neuroscience, Ospedale Civile di Baggiovara, Azienda Ospedaliera Universitaria di Modena, Italy (L.V., G.B., M.L.D., L.P., F.R., S. Maffei, S. Meletti).,Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Italy (S. Meletti)
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Italy (M.R., M.G., S.F., S.T., L.M., A.Z.)
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8
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Gardin A, Giammello F, Toscano A, Musolino RF. Severe hypomagnesaemia as new potential stroke mimic: a case report. Neurol Sci 2022; 43:4007-4009. [PMID: 35290536 PMCID: PMC8923089 DOI: 10.1007/s10072-022-06009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Gardin
- Department of Clinical and Experimental Medicine, Stroke Unit, Polyclinic Hospital, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- Department of Biomedical, Dental Science and Morphological and Functional Images, International PhD Translational Molecular Medicine and Surgery, Polyclinic Hospital, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Antonio Toscano
- Department of Clinical and Experimental Medicine, Unit of Neurology and Neuromuscular Diseases, Polyclinic Hospital, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- Department of Clinical and Experimental Medicine, Stroke Unit, Polyclinic Hospital, University of Messina, Messina, Italy
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Giammello F, Grillo F, Granata F, Galletta K, La Spina P, Toscano A, Musolino RF. Primary CNS infiltrative parenchymal histiocytosis. Pract Neurol 2022; 22:330-331. [PMID: 35470247 DOI: 10.1136/practneurol-2022-003403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Fabrizio Giammello
- International PhD Translational Molecular Medicine and Surgery - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Sicilia, Italy .,Stroke Unit - Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicilia, Italy
| | - Francesco Grillo
- Stroke Unit - Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicilia, Italy
| | - Francesca Granata
- Neuroradiology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Sicilia, Italy
| | - Karol Galletta
- Neuroradiology Unit - Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Sicilia, Italy
| | - Paolino La Spina
- Stroke Unit - Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicilia, Italy
| | - Antonio Toscano
- Unit of Neurology and Neuromuscular Disorders - Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicilia, Italy
| | - Rosa Fortunata Musolino
- Stroke Unit - Department of Clinical and Experimental Medicine, University of Messina, Messina, Sicilia, Italy
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Giammello F, De Martino SRM, Simonetti L, Agati R, Battaglia S, Cirillo L, Gentile M, Migliaccio L, Forlivesi S, Romoli M, Princiotta C, Tonon C, Stagni S, Galluzzo S, Lodi R, Trimarchi G, Toscano A, Musolino RF, Zini A. Predictive value of Tmax perfusion maps on final core in acute ischemic stroke: an observational single-center study. Radiol Med 2022; 127:414-425. [PMID: 35226245 DOI: 10.1007/s11547-022-01467-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/01/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To assess utility of computed tomography perfusion (CTP) protocols for selection of patients with acute ischemic stroke (AIS) for reperfusive treatments and compare the diagnostic accuracy (ACC) in predicting follow-up infarction, using time-to-maximum (Tmax) maps. METHODS We retrospectively reviewed consecutive AIS patients evaluated for reperfusive treatments at comprehensive stroke center, employing a multimodal computed tomography. To assess prognostic accuracy of CTP summary maps in predicting final infarct area (FIA) in AIS patients, we assumed the best correlation between non-viable tissue (NVT) and FIA in early and fully recanalized patients and/or in patients with favorable clinical response (FCR). On the other hand, the tissue at risk (TAR) should better correlate with FIA in untreated patients and in treatment failure. RESULTS We enrolled 158 patients, for which CTP maps with Tmax thresholds of 9.5 s and 16 s, presented sensitivity of 82.5%, specificity of 74.6%, and ACC of 75.9%. In patients selected for perfusion deficit in anterior circulation territory, CTP-Tmax > 16 s has proven relatively reliable to identify NVT in FCR patients, with a tendency to overestimate NVT. Similarly, CTP-Tmax > 9.5 s was reliable for TAR, but it was overestimated comparing to FIA, in patients with unfavorable outcomes. CONCLUSIONS In our experience, Tmax thresholds have proven sufficiently reliable to identify global hypoperfusion, with tendency to overestimate both NVT and TAR, not yielding satisfactory differentiation between true penumbra and benign oligoemia. In particular, the overestimation of NVT could have serious consequences in not selecting potential candidates for a reperfusion treatment.
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Affiliation(s)
- Fabrizio Giammello
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Polyclinic Hospital, Via Consolare Valeria 1, 98125, Messina, Italy.
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Sara Rosa Maria De Martino
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Bellaria Hospital, Bologna, Italy
| | - Luigi Simonetti
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Raffaele Agati
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Programma Neuroradiologia Con Tecniche Ad Elevata Complessità, Bellaria Hospital, Bologna, Italy
| | - Stella Battaglia
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Programma Neuroradiologia Con Tecniche Ad Elevata Complessità, Bellaria Hospital, Bologna, Italy
| | - Luigi Cirillo
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Bellaria Hospital, Bologna, Italy
- DIMES, Department of Specialty, Diagnostic and Experimental Medicine, University of Bologna, Bologna, Italy
| | - Mauro Gentile
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Ludovica Migliaccio
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Stefano Forlivesi
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Michele Romoli
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
| | - Ciro Princiotta
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Bellaria Hospital, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - Silvia Stagni
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Simone Galluzzo
- IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Neuroradiology Unit, Maggiore Hospital, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | | | - Antonio Toscano
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Maggiore Hospital, Bologna, Italy
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Dell'Aera C, Giammello F, Caragliano AA, Ciacciarelli A, Francalanza I, Currò CT, Pitrone A, Grillo F, Casella C, Fazio MC, La Spina P, Cotroneo M, Crea P, Toscano A, Vinci SL, Musolino RF. Repeated reperfusion treatment in recurrent ischemic stroke: A retrospective single-center case series. J Neurol Sci 2022; 434:120147. [PMID: 35033745 DOI: 10.1016/j.jns.2022.120147] [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: 08/23/2021] [Revised: 12/15/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
Data regarding repeated reperfusion therapy (rRT) in acute ischemic stroke (AIS), including intravenous thrombolysis and endovascular treatment (EVT), are quite poor. To date, there are only few case reports and five larger studies on repeated EVT. We aimed to report our single-center experience and describe different clinical scenarios of recurrent AIS with emergent large vessel occlusion (LVO), for which the decision-making process could be challenging in the emergency setting. We retrospectively reviewed 765 consecutive AIS patients with LVO, who underwent reperfusion procedures at our comprehensive stroke center, from 2014 to 2020, and identified rRT patients. We identified and reviewed the medical records of eight patients (1.05%), who repeated reperfusive treatment for recurrent stroke within 30 days (early arterial reocclusion, EAR) and after 30 days (late arterial reocclusion, LAR). We assigned collected data to three clinical scenarios, each divided into EAR and LAR cases. All patients had recurrent emergent LVO in the same vessel territory previously affected, both in EAR and LAR patients. A good clinical outcome has been achieved in EAR patients (modified Rankin Score ≤ 2). Artery-to-artery embolic mechanism was more common in the EAR group, while LAR was more frequently associated with cardioembolic source. RRT appears to be an effective treatment option for recurrent LVO, and it should not be withheld in carefully selected patients. EVT should be considered, including aspiration-only and stenting procedures in patients with AIS and recurrent LVO after previous reperfusive treatments, even after a very short time.
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Affiliation(s)
- Cristina Dell'Aera
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- International PhD Translational Molecular Medicine and Surgery, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy.
| | - Antonio Armando Caragliano
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Antonio Ciacciarelli
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Isabella Francalanza
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmelo Tiberio Currò
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Pitrone
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Francesco Grillo
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmela Casella
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Carolina Fazio
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Masina Cotroneo
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasquale Crea
- Cardiology Unit with U.T.I.C., Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Toscano
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- U.O.S.D. Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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12
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Currò CT, Cotroneo M, Ciacciarelli A, Dell'Aera C, Grillo F, La Spina P, Fazio MC, Laganà A, De Caro J, Trimarchi G, Toscano A, Musolino RF, Casella C. Ischemic Stroke and Asymptomatic Pulmonary Opacities. J Stroke Cerebrovasc Dis 2021; 31:106230. [PMID: 34864609 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106230] [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: 10/05/2021] [Accepted: 11/13/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Pulmonary opacities are described in many chest radiograph reports in stroke patients and are often asymptomatic. The aim of this study is to investigate the clinical features associated with asymptomatic pulmonary opacities (APO) and evaluate APO prognostic value in ischemic stroke. METHODS We prospectively analyzed patients with acute ischemic stroke without pneumonia symptoms referred to our stroke center. All patients underwent a chest x-ray within 48 hours after admission. We divided patients with APO (defined as asymptomatic area of increased pulmonary attenuation) and patients without APO. Firstly, we compared clinical, laboratory, and echocardiographic parameters between groups; secondly, APO were evaluated as a possible predictor of the neurological severity at discharge and functional outcome at 90 days. RESULTS We included 162 patients, 78 of whom had APO. On univariate analysis, we observed a significant difference between patients with APO and patients without APO in terms of neutrophils (73,56±10,10 vs 69,72±12,29; p=0,031), atrial fibrillation (AF, paroxysmal 27,4% vs 25,6%; permanent 19% vs 2,6%; p<0,002), cardioembolic etiology (37,2% vs 22,7%, p <0,033), thrombectomy (58,3% vs 42,9%, p <0,05), dysphagia/vomit (34,5% vs 14,10%, p<0,005), admission NIHSS (14,20±5,98 vs 10,29±5,82, p=0,001), discharge NIHSS (8,68±6,73 vs 5,64±6,20; p=0,003), and 90 days mRS (3,47±2,12 vs 2,31±1,93; p=0,001). On multivariate analysis, APO were significantly associated with admission NIHSS and AF. APO were a predictor of outcome on univariate analysis, but not on multivariate. CONCLUSION APO in acute ischemic stroke are associated with AF. APO were not a predictor of neurological and functional outcome.
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Affiliation(s)
- Carmelo Tiberio Currò
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Masina Cotroneo
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Ciacciarelli
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Carolina Fazio
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Angelina Laganà
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Jolanda De Caro
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Antonio Toscano
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmela Casella
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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13
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Gardin A, Tiberio Currò C, La Spina P, Brizzi T, Casella C, Cotroneo M, Dell'Aera C, Carolina Fazio M, Grillo F, Naro A, Cavallaro M, Galletta K, Granata F, Toscano A, Fortunata Musolino R. Spinal cord ischemia: A rare manifestation of a floating thrombus. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119641] [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: 11/24/2022]
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14
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Currò CT, Francalanza I, Cotroneo M, Dell’Aera C, Casella C, La Spina P, Fazio MC, Grillo F, Toscano A, Musolino RF. Vascular pattern and radiological follow up in a case of pontine warning syndrome. Heliyon 2021; 7:e07369. [PMID: 34222700 PMCID: PMC8242993 DOI: 10.1016/j.heliyon.2021.e07369] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/19/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
Abstract
Pontine warning syndrome (PWS) is a condition characterized by crescendo transient ischemic attacks due to pontine ischemia. The reported case described a 72-year-old woman who presented repetitive sudden episodes of double vision, impaired balance, slurred speech and right-sided weakness. Neurological deficits lasted a few minutes-hours and disappeared during the first seven days after onset. On the 1st day, MRI revealed acute left paramedian pontine infarction with focal swelling. Supra-aortic vessel imagining revealed bilateral internal carotid stenosis of 50%; hypoplasia of the left vertebral artery. On the 7th day, MRI showed a tissue swelling reduction, and from that day, she had no symptoms. These clinical and radiological features were suggestive of PWS. Our patient presented a particular vascular pattern that could favour symptoms fluctuation. We performed a close MRI follow up and it allowed us to observe a clinical stabilization in association with edema reduction.
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Affiliation(s)
- Carmelo Tiberio Currò
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
| | - Isabella Francalanza
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
| | - Masina Cotroneo
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
| | - Cristina Dell’Aera
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
| | - Carmela Casella
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
| | - Maria Carolina Fazio
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
| | - Francesco Grillo
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
| | - Antonio Toscano
- Stroke Unit, Department of Medical and Experimental Medicine, University of Messina, Italy
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15
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Giammello F, Dell'Aera C, Grillo F, Cotroneo M, Casella C, Fazio MC, La Spina P, Francalanza I, Fiorenza A, Toscano A, Atzeni F, Musolino RF. Recurrent intracranial hemorrhage and cerebral venous sinus thrombosis: an atypical case of Neuro-Behçet's Syndrome. Clin Neurol Neurosurg 2020; 191:105680. [PMID: 31981998 DOI: 10.1016/j.clineuro.2020.105680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/03/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 02/02/2023]
Abstract
We report the case of a 22-year-old man with an history of headaches, seizures, cognitive impairment associated with recurrent intracranial hemorrhage (ICH), acute ischemic stroke (AIS), worsened over the last eighteen months for a new onset of uveitis and cerebral venous sinus thrombosis (CVST). After excluding common causes of lobar ICH, and some rare ones according to the diagnostic protocol proposed by Beuker et al, in the suspicion of Primary Angiitis of the Central Nervous System (PACNS), the gradual development of a low-grade fever, a cutaneous rash, and a papulopustular manifestation on lower back after rachicentesis (pathergy phenomenon), allowed us to make a diagnosis of Neuro-Behçet's Syndrome (NBS) without oral/genital aphthous ulcerations, according to the International Study Group for Behçet's Disease classification criteria for BD (ICBD).
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Affiliation(s)
- Fabrizio Giammello
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Francesco Grillo
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Masina Cotroneo
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy.
| | - Carmela Casella
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Maria Carolina Fazio
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Paolino La Spina
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | - Isabella Francalanza
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | | | - Antonio Toscano
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
| | | | - Rosa Fortunata Musolino
- Department of Clinical and Experimental Medicine, AOU Policlinico G. Martino, University of Messina, Messina, Italy
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16
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Cotroneo M, Ciacciarelli A, Cosenza D, Casella C, Dell'Aera C, Grillo F, Fazio MC, La Spina P, Musolino RF. Hemiballism: Unusual clinical manifestation in three patients with frontoparietal infarct. Clin Neurol Neurosurg 2019; 188:105612. [PMID: 31810029 DOI: 10.1016/j.clineuro.2019.105612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 09/27/2018] [Revised: 10/09/2019] [Accepted: 11/13/2019] [Indexed: 11/18/2022]
Abstract
The term hemiballism-hemichorea refers to a movement disorder characterized by involuntary movements, often violent, described as uncontrollable jerking, flinging, flailing or kicking, involving proximal muscles of a limb and it is often associated with lesions in the subthalamic nucleus. In this report, we described three cases of hemiballism-hemichorea as the first manifestation of acute ischemic stroke with lesion in the frontoparietal region on brain MRI and no involvement of the subthalamic nucleus. One patient was treated with thrombolysis and recovered within one hour. The other patients recovered within 48 h from symptoms onset. The impairment of the recently described "hyperdirect way", in which the cortical signal reach directly the subthalamic nucleus, may underlie the symptoms. We support, with a clinical point of view, the role of the frontoparietal region in the genesis of the hemiballism-hemichorea. An acute onset of this symptom should lead to think to an acute stroke.
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Affiliation(s)
- Masina Cotroneo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Antonio Ciacciarelli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domenico Cosenza
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Carmela Casella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Grillo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Carolina Fazio
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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17
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Francalanza I, Ciacciarelli A, Caragliano AA, Casella C, Cotroneo M, Dell'Aera C, Fazio MC, Grillo F, Pitrone A, Vinci SL, Trimarchi G, Musolino RF, La Spina P. Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study. Cerebrovasc Dis Extra 2019; 9:90-97. [PMID: 31466054 PMCID: PMC6787421 DOI: 10.1159/000502084] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/10/2019] [Indexed: 01/06/2023] Open
Abstract
Background Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4′ of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95′ of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7′ of cases, 25.9′ reached mRS 0–2, and 29.6′ had a poor clinical outcome (mRS 4–5). Patient survival was 70.4′, whereas 8 patients died (29.6′). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3′ had moderate collaterals and 63.0′ had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.
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Affiliation(s)
- Isabella Francalanza
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Ciacciarelli
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Armando Caragliano
- Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Carmela Casella
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Masina Cotroneo
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Carolina Fazio
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Grillo
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Pitrone
- Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Biomedical Sciences and of Morphologic and Functional Images, University of Messina, Messina, Italy
| | | | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy,
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