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Genchi A, Semerano A, Schwarz G, Dell'Acqua B, Gullotta GS, Sampaolo M, Boeri E, Quattrini A, Sanvito F, Diamanti S, Bergamaschi A, Grassi S, Podini P, Panni P, Michelozzi C, Simionato F, Scomazzoni F, Remida P, Valvassori L, Falini A, Ferrarese C, Michel P, Saliou G, Hajdu S, Beretta S, Roveri L, Filippi M, Strambo D, Martino G, Bacigaluppi M. Neutrophils predominate the immune signature of cerebral thrombi in COVID-19 stroke patients. Acta Neuropathol Commun 2022; 10:14. [PMID: 35105380 PMCID: PMC8805426 DOI: 10.1186/s40478-022-01313-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 02/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is associated with an increased risk of thrombotic events. Ischemic stroke in COVID-19 patients entails high severity and mortality rates. Here we aimed to analyze cerebral thrombi of COVID-19 patients with large vessel occlusion (LVO) acute ischemic stroke to expose molecular evidence for SARS-CoV-2 in the thrombus and to unravel any peculiar immune-thrombotic features. We conducted a systematic pathological analysis of cerebral thrombi retrieved by endovascular thrombectomy in patients with LVO stroke infected with COVID-19 (n = 7 patients) and non-covid LVO controls (n = 23). In thrombi of COVID-19 patients, the SARS-CoV-2 docking receptor ACE2 was mainly expressed in monocytes/macrophages and showed higher expression levels compared to controls. Using polymerase chain reaction and sequencing, we detected SARS-CoV-2 Clade20A, in the thrombus of one COVID-19 patient. Comparing thrombus composition of COVID-19 and control patients, we noted no overt differences in terms of red blood cells, fibrin, neutrophil extracellular traps (NETs), von Willebrand Factor (vWF), platelets and complement complex C5b-9. However, thrombi of COVID-19 patients showed increased neutrophil density (MPO+ cells) and a three-fold higher Neutrophil-to-Lymphocyte Ratio (tNLR). In the ROC analysis both neutrophils and tNLR had a good discriminative ability to differentiate thrombi of COVID-19 patients from controls. In summary, cerebral thrombi of COVID-19 patients can harbor SARS-CoV2 and are characterized by an increased neutrophil number and tNLR and higher ACE2 expression. These findings suggest neutrophils as the possible culprit in COVID-19-related thrombosis.
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Affiliation(s)
- Angela Genchi
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Department of Neurology, San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Aurora Semerano
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Ghil Schwarz
- Department of Neurology, San Raffaele Hospital, Milan, Italy
- Department of Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Beatrice Dell'Acqua
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Department of Neurology, San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giorgia Serena Gullotta
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Michela Sampaolo
- Department of Microbiology and Virology, San Raffaele Hospital, Milan, Italy
| | - Enzo Boeri
- Department of Microbiology and Virology, San Raffaele Hospital, Milan, Italy
| | | | | | - Susanna Diamanti
- Department of Medicine and Surgery, San Gerardo Hospital and Milano-Bicocca University, Milan, Italy
| | - Andrea Bergamaschi
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Grassi
- Department of Pathology, San Raffaele Hospital, Milan, Italy
| | - Paola Podini
- Neuropathology Unit, San Raffaele Hospital, Milan, Italy
| | - Pietro Panni
- Department of Neuroradiology, San Raffaele Hospital, Milan, Italy
| | | | - Franco Simionato
- Department of Neuroradiology, San Raffaele Hospital, Milan, Italy
| | | | - Paolo Remida
- Department of Neuroradiology, San Gerardo Hospital, Monza, Italy
| | - Luca Valvassori
- Department of Neuroradiology, San Gerardo Hospital, Monza, Italy
| | - Andrea Falini
- University Vita-Salute San Raffaele, Milan, Italy
- Department of Neuroradiology, San Raffaele Hospital, Milan, Italy
| | - Carlo Ferrarese
- Department of Medicine and Surgery, San Gerardo Hospital and Milano-Bicocca University, Milan, Italy
| | - Patrik Michel
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Guillaume Saliou
- Service of Diagnostic and Interventional Radiology, Interventional Neuroradiological Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Steven Hajdu
- Service of Diagnostic and Interventional Radiology, Interventional Neuroradiological Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Simone Beretta
- Department of Medicine and Surgery, San Gerardo Hospital and Milano-Bicocca University, Milan, Italy
| | - Luisa Roveri
- Department of Neurology, San Raffaele Hospital, Milan, Italy
| | - Massimo Filippi
- Department of Neurology, San Raffaele Hospital, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Davide Strambo
- Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gianvito Martino
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Marco Bacigaluppi
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
- Department of Neurology, San Raffaele Hospital, Milan, Italy.
- University Vita-Salute San Raffaele, Milan, Italy.
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Genchi A, Semerano A, Gullotta GS, Strambo D, Schwarz G, Bergamaschi A, Panni P, Simionato F, Scomazzoni F, Michelozzi C, Pozzato M, Maugeri N, Comi G, Falini A, Roveri L, Filippi M, Martino G, Bacigaluppi M. Cerebral thrombi of cardioembolic etiology have an increased content of neutrophil extracellular traps. J Neurol Sci 2021; 423:117355. [PMID: 33647733 DOI: 10.1016/j.jns.2021.117355] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 10/14/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Inflammation is emerging as an essential trigger for thrombosis. In the interplay between innate immunity and coagulation cascade, neutrophils and neutrophil extracellular traps (NETs) can promote thrombus formation and stabilization. In ischemic stroke, it is uncertain whether the involvement of the inflammatory component may differ in thrombi of diverse etiology. We here aimed to evaluate the presence of neutrophils and NETs in cerebral thrombi of diverse etiology retrieved by endovascular thrombectomy (EVT). METHODS We performed a systematic histological analysis on 80 human cerebral thrombi retrieved through EVT in acute ischemic stroke patients. Thrombus composition was investigated in terms of neutrophils (MPO+ cells) and NET content (citH3+ area), employing specific immunostainings. NET plasma content was determined and compared to NET density in the thrombus. RESULTS Neutrophils and NETs were heterogeneously represented within all cerebral thrombi. Thrombi of diverse etiology did not display a statistically significant difference in the number of neutrophils (p = 0.51). However, NET content was significantly increased in cardioembolic compared to large artery atherosclerosis thrombi (p = 0.04), and the association between NET content and stroke etiology remained significant after adjusted analysis (beta coefficient = -6.19, 95%CI = -11.69 to -1.34, p = 0.01). Moreover, NET content in the thrombus was found to correlate with NET content in the plasma (p ≤ 0.001, r = 0.62). CONCLUSION Our study highlights how the analysis of the immune component within the cerebral thrombus, and specifically the NET burden, might provide additional insight for differentiating stroke from diverse etiologies.
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Affiliation(s)
- Angela Genchi
- Neuroimmunology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy; Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Aurora Semerano
- Neuroimmunology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy; Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Giorgia Serena Gullotta
- Neuroimmunology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Davide Strambo
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ghil Schwarz
- Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Andrea Bergamaschi
- Neuroimmunology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Pietro Panni
- Neuroradiology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Franco Simionato
- Neuroradiology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Francesco Scomazzoni
- Neuroradiology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Caterina Michelozzi
- Neuroradiology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Mattia Pozzato
- Neuroimmunology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy; Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Norma Maugeri
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Giancarlo Comi
- Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Andrea Falini
- Neuroradiology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Luisa Roveri
- Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Massimo Filippi
- Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Gianvito Martino
- Neuroimmunology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy; Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy
| | - Marco Bacigaluppi
- Neuroimmunology Unit, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy; Neurology Department, IRCCS San Raffaele Institute and University Vita- Salute San Raffaele, Via Olgettina 60, 20132 Milan, Italy.
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3
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Genchi A, Schwarz G, Semerano A, Callea M, Sanvito F, Simionato F, Panni P, Scomazzoni F, Doglioni C, Comi G, Falini A, Ancona F, Filippi M, Roveri L, Bacigaluppi M. Large vessel occlusion stroke due to dislodged aortic valve calcification revealed by imaging and histopathology. J Neurol Sci 2020; 408:116573. [PMID: 31731112 DOI: 10.1016/j.jns.2019.116573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/03/2019] [Accepted: 11/06/2019] [Indexed: 11/15/2022]
Affiliation(s)
- A Genchi
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Department of Neurology, Stroke Unit, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - G Schwarz
- Department of Neurology, Stroke Unit, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - A Semerano
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Department of Neurology, Stroke Unit, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - M Callea
- Department of Pathology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - F Sanvito
- Department of Pathology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - F Simionato
- Department of Neuroradiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - P Panni
- Department of Neuroradiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - F Scomazzoni
- Department of Neuroradiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - C Doglioni
- Department of Pathology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - G Comi
- Department of Neurology, Stroke Unit, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - A Falini
- Department of Neuroradiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - F Ancona
- Department of Cardiology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - M Filippi
- Department of Neurology, Stroke Unit, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - L Roveri
- Department of Neurology, Stroke Unit, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy
| | - M Bacigaluppi
- Neuroimmunology Unit, Institute of Experimental Neurology, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; Department of Neurology, Stroke Unit, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
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4
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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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Capitanio JF, Panni P, Gallotti AL, Gigliotti CR, Scomazzoni F, Acerno S, Del Vecchio A, Mortini P. Radiosurgical treatment of arteriovenous malformations in a retrospective study group of 33 children: the importance of radiobiological scores. Childs Nerv Syst 2019; 35:301-308. [PMID: 30474715 DOI: 10.1007/s00381-018-4008-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Arteriovenous malformations' (AVMs) obliteration depends on several factors; among the many factors that must be considered to obtain a high rate of obliteration and a low rate of complications, Flickinger-Pollock Score (FPS) seems to have an important role but still have to be validated in the pediatric population while Paddick-Conformity Index (PCI) still has no demonstration of its utility on the outcome and is considered only as a treatment quality marker. METHODS We retrospectively analyzed 33 consecutive children (2-18 years) with an AVM, treated with stereotactic radiosurgery Gamma Knife (SRS-GK) from 2001 to 2014 in our institution. We assess angiographic (DSA) Obliteration Rate (OR) as well FPS and PCI to draw conclusions. RESULTS DSA-OR was 60.6% with a rate of hemorrhage of 0%. median target volume (TV) was 3.60 cc (mean 4.32 ± 3.63; range 0.15-14.2), median PD was 22 Gy (mean 21.4 ± 2.6; range 16.5-25). Median percentage of coverage was 98% (mean 97 ± 3; range 84-100). The median modified FPS was 0.78 (mean 0.89 ± 0.52; range 0.21-2.1) and highly correlate with OR (p = 0.01). The median PCI was 0.65 (mean 0.65 ± 0.14; range 0.34-0.95) A PCI lower than 0.57 highly correlates with final OR (p = 0.02). CONCLUSION SRS-GK was safe and gradually effective in children. A prescription dose-like that used in adult population (i.e. > 18 and between 20 and 25 Gy) is essential to achieve obliteration. A PD of 23 Gy and 22 Gy did impact OR, respectively (p = 0.02) and (p = 0.05). FPS and PCI are valuable scores that seem to correlate with the OR also in the pediatric population although further prospective studies are needed to confirm these observations.
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Affiliation(s)
- Jody Filippo Capitanio
- Department of Neurosurgery and Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Pietro Panni
- Department of Neurosurgery and Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Alberto Luigi Gallotti
- Department of Neurosurgery and Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Carmen Rosaria Gigliotti
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesco Scomazzoni
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Stefania Acerno
- Department of Neurosurgery and Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Antonella Del Vecchio
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Santangelo R, Cecchetti G, Bernasconi MP, Cardamone R, Barbieri A, Pinto P, Passerini G, Scomazzoni F, Comi G, Magnani G. Cerebrospinal Fluid Amyloid-β 42, Total Tau and Phosphorylated Tau are Low in Patients with Normal Pressure Hydrocephalus: Analogies and Differences with Alzheimer's Disease. J Alzheimers Dis 2018; 60:183-200. [PMID: 28826180 DOI: 10.3233/jad-170186] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 12/12/2022]
Abstract
Co-existence of Alzheimer's disease (AD) in normal pressure hydrocephalus (NPH) is a frequent finding, thus a common pathophysiological basis between AD and NPH has been postulated. We measured CSF amyloid-β 42 (Aβ42), total tau (t-tau), and phosphorylated tau (p-tau) concentrations in a sample of 294 patients with different types of dementia and 32 subjects without dementia. We then compared scores on neuropsychological tests of NPH patients with pathological and normal CSF Aβ42 values. Aβ42 levels were significantly lower in NPH than in control patients, with no significant differences between AD and NPH. On the contrary, t-tau and p-tau levels were significantly lower in NPH than in AD, with no differences between NPH and controls. NPH patients with pathological Aβ42 levels did not perform worse than NPH patients with normal Aβ42 levels in any cognitive domains. Our data seem to support the hypothesis of amyloid accumulation in brains of NPH patients. Nevertheless, amyloid does not seem to play a pathogenetic role in the development of cognitive deficits in NPH.
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Affiliation(s)
- Roberto Santangelo
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giordano Cecchetti
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Maria Paola Bernasconi
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Rosalinda Cardamone
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Alessandra Barbieri
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Patrizia Pinto
- Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Francesco Scomazzoni
- Department of Neuroradiology, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giancarlo Comi
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
| | - Giuseppe Magnani
- Department of Neurology, INSPE, Vita-Salute University and IRCCS-San Raffaele Hospital, Milan, Italy
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Simionato F, Scomazzoni F, Righi C. GDC Embolization of Three Intracranial Wide-Neck Aneurysms Using a Novel Self-Expandable Nitinol Microstent. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/197140090301600123] [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] [Indexed: 11/17/2022]
Affiliation(s)
- F. Simionato
- Servizio di Neuroradiologia, Istituto Scientifico San Raffaele, Milano; Italy
| | - F. Scomazzoni
- Servizio di Neuroradiologia, Istituto Scientifico San Raffaele, Milano; Italy
| | - C. Righi
- Servizio di Neuroradiologia, Istituto Scientifico San Raffaele, Milano; Italy
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Capitanio JF, Gallotti AL, Panni P, Snider S, Scomazzoni F, Mortini P. 204 Pediatrics Arteriovenous Malformations Treatment With Stereotactic Radiosurgery Gamma Knife. Neurosurgery 2016. [DOI: 10.1227/01.neu.0000489773.66889.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bracard S, Anxionnat R, Da Costa E, Lebedinsky A, Scomazzoni F, Picard L. Combined Endovascular Stenting and Endosaccular Coiling for the Treatment of a Wide-Necked Intracranial Vertebral Aneurysm. Interv Neuroradiol 2016; 5:245-9. [DOI: 10.1177/159101999900500307] [Citation(s) in RCA: 4] [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: 07/15/1999] [Accepted: 07/25/1999] [Indexed: 11/16/2022] Open
Abstract
We describe a clinical case of the combined application of endovascular stent placement and GDCoils packing in the management of a ruptured wide necked intracranial aneurysm. A 27-year-old man had a subarachnoid haemorrhage secondary to the rupture of a large wide necked left vertebral aneurysm. This aneurysm was judged to be inoperable. A functional occlusion test failed because of poor collateral flow and combined stenting and coiling was used to occlude the aneurysm with preservation of the parent artery. A femoral approach was used. An 18 mm long ACS® Duet stent was placed across the base of aneurysm and expanded to 4mm to act as a buttress. A microcatheter was then advanced through the stent mesh and GDC's were deposited for occlusion. This technique provides new possibilities for wide-necked intracranial aneurysms. Further studies are required on the mechanical and thrombogenic properties of stents and on the long-term follow-up, but this technology may play a role in some cases of aneurysm treatment.
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Affiliation(s)
- S. Bracard
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - R. Anxionnat
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - E. Da Costa
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - A. Lebedinsky
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - F. Scomazzoni
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
| | - L. Picard
- Service de Neuroradiology Diagnostique et Therapeutique; Hôpital Neurologique CHU Nancy, France
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Cirillo M, Scomazzoni F, Cirillo L, Cadioli M, Simionato F, Iadanza A, Kirchin M, Righi C, Anzalone N. Comparison of 3D TOF-MRA and 3D CE-MRA at 3T for imaging of intracranial aneurysms. Eur J Radiol 2013; 82:e853-9. [PMID: 24103356 DOI: 10.1016/j.ejrad.2013.08.052] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 07/23/2013] [Revised: 08/28/2013] [Accepted: 08/30/2013] [Indexed: 01/22/2023]
Abstract
PURPOSE To compare 3T elliptical-centric CE MRA with 3T TOF MRA for the detection and characterization of unruptured intracranial aneurysms (UIAs), by using digital subtracted angiography (DSA) as reference. MATERIALS AND METHODS Twenty-nine patients (12 male, 17 female; mean age: 62 years) with 41 aneurysms (34 saccular, 7 fusiform; mean diameter: 8.85 mm [range 2.0-26.4mm]) were evaluated with MRA at 3T each underwent 3D TOF-MRA examination without contrast and then a 3D contrast-enhanced (CE-MRA) examination with 0.1mmol/kg bodyweight gadobenate dimeglumine and k-space elliptic mapping (Contrast ENhanced Timing Robust Angiography [CENTRA]). Both TOF and CE-MRA images were used to evaluate morphologic features that impact the risk of rupture and the selection of a treatment. Almost half (20/41) of UIAs were located in the internal carotid artery, 7 in the anterior communicating artery, 9 in the middle cerebral artery and 4 in the vertebro-basilar arterial system. All patients also underwent DSA before or after the MR examination. RESULTS The CE-MRA results were in all cases consistent with the DSA dataset. No differences were noted between 3D TOF-MRA and CE-MRA concerning the detection and location of the 41 aneurysms or visualization of the parental artery. Differences were apparent concerning the visualization of morphologic features, especially for large aneurysms (>13 mm). An irregular sac shape was demonstrated for 21 aneurysms on CE-MRA but only 13/21 aneurysms on 3D TOF-MRA. Likewise, CE-MRA permitted visualization of an aneurismal neck and calculation of the sac/neck ratio for all 34 aneurysms with a neck demonstrated at DSA. Conversely, a neck was visible for only 24/34 aneurysms at 3D TOF-MRA. 3D CE-MRA detected 15 aneurysms with branches originating from the sac and/or neck, whereas branches were recognized in only 12/15 aneurysms at 3D TOF-MRA. CONCLUSION For evaluation of intracranial aneurysms at 3T, 3D CE-MRA is superior to 3D TOF-MRA for assessment of sac shape, detection of aneurysmal neck, and visualization of branches originating from the sac or neck itself, if the size of the aneurysm is greater than 13 mm. 3T 3D CE-MRA is as accurate and effective as DSA for the evaluation of UIAs.
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Affiliation(s)
- Mario Cirillo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences - 2nd University of Naples, Italy.
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Franzin A, Snider S, Boari N, Scomazzoni F, Picozzi P, Spatola G, Gagliardi F, Mortini P. Evaluation of prognostic factors as predictor of AVMS obliteration after Gamma Knife radiosurgery. Acta Neurochir (Wien) 2013; 155:619-26. [PMID: 23420116 DOI: 10.1007/s00701-013-1631-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND The reported AVMs obliteration rate after Gamma Knife radiosurgery (GKS) ranges from 70 to 94 %. The objective of the present study was to assess prognostic factors predictive for cerebral AVMs obliteration in 127 patients who underwent GKS. METHODS The AVMs were classified according to the Spetzler-Martin classification. Twenty-one cases (16.5 %) were classified as grade I, 46 cases (36.2 %) as grade II, 51 cases (40.1 %) as grade III, and nine cases (7.1 %) as grade IV-V. The AVMs were deeply located in 16.5 % of patients. The peripheral prescription dose ranged from 16 to 30 Gy (mean 22.3 Gy). The AVMs volume ranged from 0.1 to 13 cc (mean 2.7 cc). RESULTS In 72 patients out of the 104 (69.2 %) with a radiological follow-up, MRI showed the AVM obliteration; in 54 cases (60 %) out of the 90 that performed a DSA, a complete AVM obliteration was achieved (average closure time 48.5 months). The volume of the nidus (p = 0.001), the prescription dose (p = 0.004), the 2002 Pollock-Flickinger classification (p = 0.031), and their 2008 revised classification (p = 0.025) were found to be statistically significant in predicting the probability of AVM closure. In the multivariate analysis, only the prescription dose was found to be an independent prognostic factor (p = 0.009) for AVM obliteration. CONCLUSIONS The volume of the nidus and the prescription dose significantly influence the outcome of radiosurgical treatment. The Pollock-Flickinger classification was found to be a reliable scoring system in predicting the AVM closure and an important tool for selection of patients candidate for GKS.
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Ciccone A, Valvassori L, Ponzio M, Ballabio E, Gasparotti R, Sessa M, Scomazzoni F, Tiraboschi P, Sterzi R. Intra-arterial or intravenous thrombolysis for acute ischemic stroke? The SYNTHESIS pilot trial. J Neurointerv Surg 2009; 2:74-9. [PMID: 21990564 DOI: 10.1136/jnis.2009.001388] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the feasibility, safety and preliminary efficacy of intra-arterial thrombolysis (IAT) compared with standard intravenous thrombolysis (IVT) for acute ischemic stroke. METHODS Eligible patients with ischemic stroke, who were devoid of contraindications, started IVT within 3 h or IAT as soon as possible within 6 h. Patients were randomized within 3 h of onset to receive either intravenous alteplase, in accordance with the current European labeling, or up to 0.9 mg/kg intra-arterial alteplase (maximum 90 mg), over 60 min into the thrombus, if necessary with mechanical clot disruption and/or retrieval. The purpose of the study was to determine the proportion of favorable outcome at 90 days. Safety endpoints included symptomatic intracranial hemorrhage (SICH), death and other serious adverse events. RESULTS 54 patients (25 IAT) were enrolled. Median time from stroke onset to start to treatment was 3 h 15 min for IAT and 2 h 35 min for IVT (p<0.001). Almost twice as many patients on IAT as those on IVT survived without residual disability (12/25 vs 8/29; OR 3.2; 95% CI 0.9 to 11.4; p=0.067). SICH occurred in 2/25 patients on IAT and in 4/29 on IVT (OR 0.5; CI 0.1 to 3.3; p=0.675). Mortality at day 7 was 5/25 (IAT) compared with 4/29 (IVT) (OR 1.6; CI 0.4 to 6.7; p=0.718). There was no significant difference in the rate of other serious adverse events. CONCLUSIONS Rapid initiation of IAT is a safe and feasible alternative to IVT in acute ischemic stroke.
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Affiliation(s)
- A Ciccone
- Department of Neurology, Stroke Unit, 'Niguarda Ca' Granda' Hospital, Milan, Italy.
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Anzalone N, Scomazzoni F, Cirillo M, Righi C, Simionato F, Cadioli M, Iadanza A, Kirchin MA, Scotti G. Follow-up of coiled cerebral aneurysms at 3T: comparison of 3D time-of-flight MR angiography and contrast-enhanced MR angiography. AJNR Am J Neuroradiol 2008; 29:1530-6. [PMID: 18556359 DOI: 10.3174/ajnr.a1166] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to compare contrast-enhanced MR angiography (CE-MRA) and 3D time-of-flight (TOF) MRA at 3T for follow-up of coiled cerebral aneurysms. MATERIALS AND METHODS Fifty-two patients treated with Guglielmi detachable coils for 54 cerebral aneurysms were evaluated at 3T MRA. 3D TOF MRA (TR/TE = 23/3.5; SENSE factor = 2.5) and CE-MRA by using a 3D ultrafast gradient-echo sequence (TR/TE = 5.9/1.8; SENSE factor = 3) enhanced with 0.1-mmol/kg gadobenate dimeglumine were performed in the same session. Source images, 3D maximum intensity projection, 3D shaded surface display, and/or 3D volume-rendered reconstructions were evaluated in terms of aneurysm occlusion/patency and artifact presence. RESULTS In terms of clinical classification, the 2 MRA sequences were equivalent for 53 of the 54 treated aneurysms: 21 were considered fully occluded, whereas 16 were considered to have a residual neck and 16 were considered residually patent at follow-up MRA. The remaining aneurysm appeared fully occluded at TOF MRA but had a residual patent neck at CE-MRA. Visualization of residual aneurysm patency was significantly (P = .001) better with CE-MRA compared with TOF MRA for 10 (31.3%) of the 32 treated aneurysms considered residually patent with both sequences. Coil artifacts were present in 5 cases at TOF MRA but in none at CE-MRA. No relationship was apparent between the visualization of patency and either the size of the aneurysm or the interval between embolization and follow-up. CONCLUSION At follow-up MRA at 3T, unenhanced TOF and CE-MRA sequences are similarly effective at classifying coiled aneurysms as occluded or residually patent. However, CE-MRA is superior to TOF MRA for visualization of residual patency and is associated with fewer artifacts.
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Affiliation(s)
- N Anzalone
- Department of Neuroradiology, Ospedale San Raffaele, Milan, Italy.
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Ciccone A, Valvassori L, Gasparotti R, Scomazzoni F, Ballabio E, Sterzi R. Debunking 7 myths that hamper the realization of randomized controlled trials on intra-arterial thrombolysis for acute ischemic stroke. Stroke 2007; 38:2191-5. [PMID: 17540973 DOI: 10.1161/strokeaha.106.465567] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although intravenous (IV) thrombolysis is the standard treatment for patients with ischemic stroke occurring within 3 hours from symptom onset, a few interventional neuroradiologists have been treating this category of patients by an intra-arterial (IA) route for >25 years. However, evidence is still required to support the clinical feeling that IA treatment, which needs longer time and greater complexity, leads to a better outcome. Therefore, the objective of the present review was to analyze beliefs and myths underlying the selection of patients for IA thrombolysis. METHODS We identified and debunked the following myths on IA thrombolysis: (1) IA thrombolysis works better than IV because it achieves higher recanalization rates; (2) IA thrombolysis works better than IV after the 3-hour window; (3) IA thrombolysis works better than IV in vertebrobasilar stroke; (4) carotid duplex, transcranial doppler, CT angiography, or MRA should be used to screen for major vessel occlusion treatable with IA thrombolysis; (5) to be treated with IA thrombolysis, patients should be selected with diffusion/perfusion MRI; (6) IA thrombolysis should be used as a "rescue" therapy for IV thrombolysis; and (7) the efficacy of IA thrombolysis depends on the thrombolytic agent or the device used. CONCLUSIONS Evidence on acute stroke management with IA thrombolysis is scant. Therefore, neither clinicians nor patients have enough information to make truly informed decisions about the most appropriate treatment. Only randomized controlled trials can clear uncertainties about the possible superiority of IA over IV thrombolysis. Regretfully, case series on IA treatment have limited the organization of such trials and have only favored the spread of myths.
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Affiliation(s)
- Alfonso Ciccone
- Stroke Unit and Department of Neurology, Niguarda Ca' Granda Hospital, Milan, Italy.
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Anzalone N, Scomazzoni F, Castellano R, Strada L, Righi C, Politi LS, Kirchin MA, Chiesa R, Scotti G. Carotid Artery Stenosis: Intraindividual Correlations of 3D Time-of-Flight MR Angiography, Contrast-enhanced MR Angiography, Conventional DSA, and Rotational Angiography for Detection and Grading. Radiology 2005; 236:204-13. [PMID: 15955853 DOI: 10.1148/radiol.2361032048] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare three-dimensional (3D) time-of-flight (TOF) MR angiography, contrast-enhanced MR angiography, digital subtraction angiography (DSA), and rotational angiography for depiction of stenosis. MATERIALS AND METHODS The study had Ethics Committee approval, and each patient gave written informed consent. Forty-nine patients (18 women, mean age, 67.2 years +/- 9.1 [+/- standard deviation], and 31 men, mean age, 63.1 years +/- 8.0) with symptomatic stenosis of internal carotid artery (ICA) diagnosed at duplex ultrasonography underwent transverse 3D TOF MR angiography with sliding interleaved kY acquisition and coronal contrast-enhanced MR angiography, followed by DSA and rotational angiography within 48 hours. MR angiography was performed at 1.5-T with a cervical coil. Contrast-enhanced MR angiograms were obtained after a bolus injection of 20 mL of gadobenate dimeglumine. Maximum ICA stenosis on maximum intensity projection and source images was quantified according to NASCET criteria. Correlations for 3D TOF MR angiography, contrast-enhanced MR angiography, DSA, and rotational angiography were determined by means of cross tabulation, and accuracy for detection and grading of stenoses were calculated. Data were evaluated with analysis of variance, Wilcoxon signed rank test, and McNemar test, all at significance of P < .05. RESULTS Ninety-eight ICAs were evaluated at contrast-enhanced MR angiography, DSA, and rotational angiography, and 97 were evaluated at 3D TOF MR angiography. Correlations for contrast-enhanced MR angiography, 3D TOF MR angiography, and DSA relative to rotational angiography were r2 = 0.9332, r2 = 0.9048, and r2 = 0.9255, respectively. Lower correlation (r2 = 0.8593) was noted for contrast-enhanced MR angiography and DSA. Respective sensitivity and specificity for detection of hemodynamically relevant stenosis relative to rotational angiography were 100% and 90% for contrast-enhanced MR angiography, 95.5% and 87.2% for 3D TOF MR angiography, and 88.6% and 100% for DSA. Four of 31 severe stenoses were underestimated at DSA, and three were underestimated at contrast-enhanced MR angiography. Three severe stenoses were underestimated at 3D TOF MR angiography, and one was misclassified as occluded. Of 13 moderate (50%-69%) stenoses, one was overestimated at contrast-enhanced MR angiography, two were underestimated and three overestimated at 3D TOF MR angiography, and two were underestimated at DSA. CONCLUSION DSA results in an underestimation of ICA stenosis compared with rotational angiography. Contrast-enhanced MR angiography correlates best with rotational angiography.
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Affiliation(s)
- Nicoletta Anzalone
- Department of Neuroradiology, Scientific Institute, Ospedale San Raffaele, Milan 20132, Italy. anzalone@
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Mandelli C, Bernucci C, Mortini P, Tartara F, Scomazzoni F, Giovanelli M. Chondrosarcoma of the thoracic spine: total en bloc sagittal resection. A case report. J Neurosurg Sci 2001; 45:114-9. [PMID: 11533537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Chondrosarcomas located in the spine are uncommon tumors and are challenging to manage. A case of a 65-year-old man with a T3-T4 spine chondrosarcoma is reported. The onset of symptoms consisted in progressive dorsal pain with sometimes a girdle-like radiation and, successively, in dysaesthesia and paresthesia from the lower limbs to the thoracic region. After preoperative oncologic and surgical planning the patient underwent a total en bloc resection of the mass. No postoperative adjunctive neurological deficits were recorded. An adjuvant radiation therapy with a dose of 5.500 centigrays (cGy) over four weeks was performed. At one year follow-up the patient is alive with no signs of recurrence on computed tomographic scans and magnetic resonance imaging. We discuss this case with particular emphasis on the preoperative planning, the surgical procedure and related prognosis.
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Affiliation(s)
- C Mandelli
- Department of Neurosurgery, IRCCS San Raffaele, University of Milan, Milan, Italy.
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Anxionnat R, Bracard S, Ducrocq X, Trousset Y, Launay L, Kerrien E, Braun M, Vaillant R, Scomazzoni F, Lebedinsky A, Picard L. Intracranial aneurysms: clinical value of 3D digital subtraction angiography in the therapeutic decision and endovascular treatment. Radiology 2001; 218:799-808. [PMID: 11230659 DOI: 10.1148/radiology.218.3.r01mr09799] [Citation(s) in RCA: 174] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate three-dimensional (3D) digital subtraction angiography (DSA) as a supplement to two-dimensional (2D) DSA in the endovascular treatment (EVT) of intracranial aneurysms. MATERIALS AND METHODS In 22 ruptured aneurysms, neck visualization, aneurysm shape, and EVT feasibility were analyzed at 2D DSA (anteroposterior, lateral, and rotational views) and at maximum intensity projection (MIP) and surface shaded display (SSD) 3D DSA. The possibility of obtaining a working view for EVT at 3D DSA and the relevance of measurements in choosing the first coil also were assessed. RESULTS Two-dimensional DSA images clearly depicted the aneurysm neck in four of 22 aneurysms; MIP images, in 10; and SSD images, in 21, but SSD led to overestimation of the neck size in one aneurysm. Aneurysm shape was precisely demonstrated in five of 22 aneurysms at 2D DSA, in eight at MIP, and in all cases at SSD. In two of 22 aneurysms, EVT seemed to be nonfeasible at 2D DSA; however, SSD demonstrated feasibility and EVT was successfully performed. In one aneurysm, only SSD demonstrated the extension of the neck to a parent vessel, which was proved at surgery. Working views for EVT were deduced from 3D DSA findings in 20 of 21 aneurysms. The choice of the first coil was correct in 19 of 21 aneurysms. CONCLUSION Three-dimensional DSA is valuable for evaluating the potential for EVT, finding a working view, and performing accurate measurements.
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Affiliation(s)
- R Anxionnat
- Departments of Diagnostic and Interventional Neuroradiology, University Hospital, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France.
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Anzalone N, Righi C, Simionato F, Scomazzoni F, Pagani G, Calori G, Santino P, Scotti G. Three-dimensional time-of-flight MR angiography in the evaluation of intracranial aneurysms treated with Guglielmi detachable coils. AJNR Am J Neuroradiol 2000; 21:746-52. [PMID: 10782789 PMCID: PMC7976624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND PURPOSE Intravascular treatment of intracranial aneurysms is a relatively new therapeutic technique and long-term controlled angiographic trials are needed to assess persistence of aneurysm occlusion. Our purpose was to evaluate the effectiveness of 3D time-of-flight (3D-TOF) MR angiography as a noninvasive screening tool in the follow-up of cerebral aneurysms treated with Guglielmi detachable coils (GDCs). METHODS Forty-nine patients with 50 intracranial aneurysms previously treated with GDCs were studied with both DSA and 3D-TOF MR angiography. In 14 cases, a second follow-up examination was performed, for a total of 64 aneurysms evaluated. In 25 aneurysms, both pre- and postcontrast MR angiographic studies were obtained. RESULTS In seven of 64 aneurysms, the MR angiographic studies were considered to be unreliable owing to the presence of artifacts that obscured part of the parent artery and did not allow an accurate evaluation of the aneurysm neck. These seven aneurysms, however, all were shown to be completely occluded at digital subtraction angiography (DSA). In the remaining 57 aneurysms, DSA revealed complete occlusion in 39 and the presence of residual patency in 18, whereas MR angiography showed complete occlusion in 38 and residual patency in 19. Enhanced MR angiography proved to be useful in evaluating residual patency in large and giant aneurysms and in better depicting the distal branch arteries. CONCLUSION Although artifacts related to the presence of coils are evident on a considerable number of imaging studies, our findings indicate that MR angiography is useful in the evaluation of residual patency of cerebral aneurysms treated with GDCs and may eventually prove valuable in the follow-up of those cases in which a good initial correlation with DSA was demonstrated.
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Affiliation(s)
- N Anzalone
- Department of Neuroradiology, Scientific Institute H San Raffaele, Milan, Italy
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Pocar M, Moneta A, Pelenghi S, Donatelli F, Tresoldi F, Scomazzoni F, Grossi A. Mycotic aortic aneurysm presenting as multiple cerebral abscesses. Acta Neurochir (Wien) 1998; 140:289-90. [PMID: 9638268 DOI: 10.1007/s007010050098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 68-year-old male presented with multiple cerebral abscesses. Possible intrathoracic embolic sources were not detected by echocardiography and chest radiography and the main lesion was surgically excised. Following deterioration of the neurological status, computerized tomography performed 2 weeks later revealed a mycotic aneurysm of the ascending aorta, probably related to a previous cardiac operation. This is the first case in the literature of aortic infection presenting as multiple brain abscesses.
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MESH Headings
- Aged
- Aneurysm, Infected/complications
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/pathology
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/pathology
- Aortic Aneurysm, Thoracic/complications
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/pathology
- Brain Abscess/diagnostic imaging
- Brain Abscess/etiology
- Brain Abscess/pathology
- Diagnosis, Differential
- Fatal Outcome
- Humans
- Klebsiella Infections/diagnostic imaging
- Klebsiella Infections/etiology
- Klebsiella Infections/pathology
- Male
- Parietal Lobe/diagnostic imaging
- Parietal Lobe/pathology
- Staphylococcal Infections/diagnostic imaging
- Staphylococcal Infections/etiology
- Staphylococcal Infections/pathology
- Staphylococcus epidermidis
- Tomography, X-Ray Computed
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Affiliation(s)
- M Pocar
- Istituto di Malattie dell'Apparato Cardiovascolare e Respiratorio, Università degli Studi di Milano, Italy
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Abstract
Many efforts and much research have been dedicated to the field of non-invasive angiographic techniques in the past few years. Thanks first to magnetic resonance angiography (MRA) and subsequently to computed tomographic angiography (CTA), very interesting results have been obtained in the diagnosis of cerebrovascular diseases. Neck vessels are most successfully evaluated by both MRA and CTA, and the need for digital subtraction angiography (DSA) examinations in patients at risk for vascular occlusions has significantly decreased. The role and the diagnostic accuracy of these non-invasive modalities in intracranial vascular pathology is still under investigation, and several studies have been and are being performed. Both techniques have a better spatial resolution and sensitivity in detecting cerebrovascular malformations than DSA. In the diagnosis of cerebral aneurysms, both MRA and CTA - due to their high sensitivity - have become screening techniques in the population at risk for subarachnoid hemorrhage, these techniques may become basic diagnostic modalities in treatment planning. The results are less satisfying in the evaluation of brain arteriovenous malformations and in the different steps of pre- and post-therapeutic evaluation.
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Affiliation(s)
- N Anzalone
- Department of Neuroradiology, Scientific Institute H. S. Raffaele, Via Olgettina 60, I-20122 Milan, Italy
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Triulzi F, Parazzini C, Bianchini E, Scomazzoni F, Scotti G. Cerebellar astrocytomas. Rays 1993; 18:532-40. [PMID: 8047667] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- F Triulzi
- Servizio di Neuroradiologia, H.S. Raffaele, Milano, Italy
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Scotti G, Triulzi F, Pieralli S, Lipari S, Scomazzoni F, Losa M. Modern imaging techniques in GH secretory disorders. J Pediatr Endocrinol Metab 1993; 6:345-56. [PMID: 7921004 DOI: 10.1515/jpem.1993.6.3-4.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Magnetic resonance images of the pituitary-hypothalamic area in patients with GH secretory disorders, divided into two groups (hypersecretory and hyposecretory), were studied. In the first group there were 42 patients with pituitary adenoma; size, signal characteristics, direction of growth, and type of enhancement were analyzed and compared with similar studies in 40 age and sex matched control patients with non-GH secreting pituitary adenomas. No significant differences were found except for a higher frequency of chiasm involvement and a more pronounced contrast enhancement in the control group. The hyposecretory group was composed of 101 patients with congenital idiopathic growth hormone deficiency (CIGHD). MR revealed morphological abnormalities consisting of hypoplastic anterior pituitary and ectopic posterior pituitary (PPE) in 59 patients, without evidence of a complete pituitary stalk; in 42 patients the posterior pituitary was in normal position and the pituitary stalk visible. The group with PPE showed a greater frequency of multiple pituitary hormone deficiency (51% vs 12%), breech delivery (30% vs 7%) and associated congenital brain anomalies (12% vs 7%). These data suggest that CIGHD could be the result of a congenital midline brain anomaly in a significant proportion of patients.
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Affiliation(s)
- G Scotti
- Department of Neuroradiology, Ospedale San Raffaele, University of Milan, Italy
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