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Parodi F, Severi I, Flora G, Cioni S, Vallone IM, Betti V, Martini G, Tassi R. Concurrent subarachnoid haemorrhage and internal carotid artery dissection: a transcranial colour-coded sonography diagnosis. J Ultrasound 2023; 26:771-776. [PMID: 35482247 PMCID: PMC10632309 DOI: 10.1007/s40477-022-00686-z] [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: 03/15/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022] Open
Abstract
We report the case of a young woman affected by an aneurysmal subarachnoid haemorrhage (SAH) and numerous anatomic abnormalities. A Transcranial Colour-Coded Duplex Sonography, performed with the aim of monitoring the vasospasm, showed a non-pulsatile flow with loss of sharp systolic peak and lowering of mean flow velocities in the right extracranial Internal Carotid Artery (ICA) and all its intra-cranial branches. This event suggested a possible concomitant acute right ICA sub-occlusion with a lack of collateral circulation. This type of flow is typically found in systemic and brain arteries of patients undergoing to venous-arterial extracorporeal membrane oxygenation or to left ventricular assist devices. The absence of an adequate cerebral collateral circulation might be the explanation for this type of atypical flow. Aneurysms and arterial dissections contribute to SAH and ischemic stroke events, leading to long-term physical and cognitive disability. In our case, the prompt neurosonological diagnosis leaded to patient's good outcome.
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Affiliation(s)
- Francesca Parodi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Ilaria Severi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Giammarco Flora
- Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Samuele Cioni
- Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Ignazio Maria Vallone
- Unit of Interventional Neuroradiology, Department of Neurology and Human Movement Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Veronica Betti
- Anesthesia and Neuro-ICU, Department of Neurological and Sensorineural, Azienda Opsedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Giuseppe Martini
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Department of Emergency and Transplantation, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria Alle Scotte", Viale Mario Bracci, 16, 53100, Siena, Italy.
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Gennaro P, Cioni S, Bracco S, Cascino F, Latini L, Abbagnato M, Massarelli O, Gabriele G. A Single-Center Retrospective Analysis of 14 Head and Neck AVMs Cases Treated with a Single-Day Combined Endovascular and Surgical Approach. J Pers Med 2023; 13:jpm13050757. [PMID: 37240927 DOI: 10.3390/jpm13050757] [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: 03/12/2023] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Arteriovenous malformations (AVMs) are rare congenital defects of vascular development whose treatment remains challenging. The paper presents a retrospective single-center study of 14 patients with AVMs of the head and neck region undergoing combined endovascular and surgical treatment in a single day. AVM architecture and therapeutic strategies were determined on the basis of angiographic studies, while the psychological involvement of each patient was assessed by means of a questionnaire. Most of the 14 patients achieved satisfactory clinical results with no recurrences, good aesthetic and functional results, and most patients reported improved quality of life. The combined endovascular and surgical approach is an effective treatment for AVMs of the head and neck and performing it on the same day is a possible option often accepted by patients which guarantees operative advantages for the surgeon.
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Affiliation(s)
- Paolo Gennaro
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Samuele Cioni
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Sandra Bracco
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Flavia Cascino
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Linda Latini
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Manfredi Abbagnato
- Neuroimaging and Neurointervention Unit, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Olindo Massarelli
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
| | - Guido Gabriele
- Maxillofacial Surgery Operative Unit, Department of Mental Health and Sense Organs, Santa Maria Le Scotte, University Hospital of Siena, 53100 Siena, Italy
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Acampa M, Guideri F, Bracco S, Tassi R, Domenichelli C, Lazzerini PE, Cioni S, Martini G. Safety of intravenous thrombolysis and mechanical thrombectomy in bilateral posterior cerebral artery territory infarction. Curr Drug Saf 2021; 17:274-278. [PMID: 34629044 DOI: 10.2174/1574886316666211008140212] [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: 06/27/2021] [Revised: 07/01/2021] [Accepted: 08/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute bilateral blindness is an uncommon phenomenon, that requires immediate diagnosis and action. The emergent evaluation should concentrate on an early distinction between ocular, cortical, and psychogenic etiologies. OBJECTIVE To present a case of cortical blindness without anosognosia due to the embolic occlusion of both posterior cerebral arteries (PCAs) and treated by intravenous and mechanical thrombolysis. CASE REPORT A 67-year-old woman was admitted to the Stroke Unit due to cortical blindness without anosognosia. At the admission to the Hospital an emergent computed tomography scan of the brain ruled out intracranial acute hemorrhage and showed subtle changes consistent with hyperacute ischemia of the left occipital cortex, while a CT angiography demonstrated the occlusion of the P3 segment of both right and left posterior cerebral arteries. The patient was treated with combined thrombolysis (intravenous and mechanical thrombolysis), obtaining the complete revascularization and a significant clinical improvement. CONCLUSION Even if there is no randomized controlled trial to compare the effectiveness and safety of mechanical thrombectomy (MT) to intravenous thrombolysis in patients with posterior circulation occlusion, the good outcome of this case encourages combined stroke treatments in posterior circulation stroke, even in case of mild but disabling neurological deficits.
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Affiliation(s)
- Maurizio Acampa
- Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General-Hospital, Siena. Italy
| | - Francesca Guideri
- Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General-Hospital, Siena. Italy
| | - Sandra Bracco
- Interventional Neuroradiology Unit, Azienda Ospedaliera Universitaria Senese University of Siena, Policlinico "Santa Maria alle Scotte" Siena. Italy
| | - Rossana Tassi
- Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General-Hospital, Siena. Italy
| | - Carlo Domenichelli
- Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General-Hospital, Siena. Italy
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena. Italy
| | - Samuele Cioni
- Interventional Neuroradiology Unit, Azienda Ospedaliera Universitaria Senese University of Siena, Policlinico "Santa Maria alle Scotte" Siena. Italy
| | - Giuseppe Martini
- Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, "Santa Maria alle Scotte" General-Hospital, Siena. Italy
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Diana F, Vinci SL, Ruggiero M, Semeraro V, Bracco S, Frauenfelder G, Paolucci A, Cirillo L, Pesce A, Tessitore A, Commodaro C, Ganimede MP, Zanoni M, Saponiero R, Zini A, Velo M, Modello B, Burdi N, Cioni S, Simonetti L, Romano DG. Comparison of aspiration versus combined technique as first-line approach in terminal internal carotid artery occlusion: a multicenter experience. J Neurointerv Surg 2021; 14:666-671. [PMID: 34349012 DOI: 10.1136/neurintsurg-2021-017585] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/29/2021] [Accepted: 07/17/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is no consensus on the most effective endovascular technique to use in patients with acute ischemic stroke due to terminal internal carotid artery (ICA) occlusion. The aim of this study was to compare safety and efficacy of the aspiration technique (AT) and combined technique (CT) as first-line approach in terminal ICA occlusions. METHODS We performed a retrospective analysis of prospectively collected databases from seven Italian stroke centers. Patients were divided into two subgroups according to the first-line approach: AT group or CT group. We followed the STROBE guidelines for cohort studies. We used Chi-square test, one-way and multivariate ANOVA analysis, together with contrast analysis and post hoc tests, logistic regression and Pearson's bivariate correlation for the statistical analyses. RESULTS Between January 2018 and August 2020, 353 patients were treated for a terminal ICA occlusion, with either AT or CT. CT was associated with a higher Thrombolysis in Cerebral Infarction (TICI) 2B-3 after the first pass (51.0% vs 26.9%) and at the end of the procedure (84% vs 73.3%) and with an improved clinical outcome at discharge (modified Rankin Scale (mRs) 0-2 of 47.8% vs 34.0%) and at 3 months' follow-up (mRs 0-2 of 56.5% vs 38.9%) compared with AT. CONCLUSION Thrombectomy of terminal ICA occlusions obtained using CT as first-line approach demonstrated better technical and functional outcomes in comparison with AT.
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Affiliation(s)
- Francesco Diana
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Sergio Lucio Vinci
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Maria Ruggiero
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Vittorio Semeraro
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Sandra Bracco
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Giulia Frauenfelder
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Aldo Paolucci
- Unit of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Luigi Cirillo
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy.,DIBINEM, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alessandro Pesce
- Department of Neurosurgery, Ospedale Santa Maria Goretti, Latina, Italy
| | - Agostino Tessitore
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Christian Commodaro
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Maria Porzia Ganimede
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Matteo Zanoni
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Renato Saponiero
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Mariano Velo
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Beatrice Modello
- Neuroradiology Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy
| | - Nicola Burdi
- Department of Diagnostic and Interventional Imaging, Santissima Annunziata Hospital, Taranto, Italy
| | - Samuele Cioni
- Unit of Interventional Neuroradiology, Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria Alle Scotte", Siena, Italy
| | - Luigi Simonetti
- Neuroradiology Unit, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | - Daniele Giuseppe Romano
- Department of Neuroradiology, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona, University of Salerno, Salerno, Italy
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Cappellari M, Saia V, Pracucci G, Sallustio F, Gandini R, Nappini S, Nencini P, Vallone S, Zini A, Bigliardi G, Granata F, Grillo F, Cioni S, Tassi R, Bergui M, Cerrato P, Saletti A, De Vito A, Gasparotti R, Magoni M, Taglialatela F, Ruggiero M, Longoni M, Castellan L, Malfatto L, Menozzi R, Castellini P, Cosottini M, Mancuso M, Comai A, Franchini E, Lozupone E, Della Marca G, Ciceri EFM, Bonetti B, Zampieri P, Inzitari D, Mangiafico S, Toni D. Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset: Bridging therapy versus direct thrombectomy in unknown onset stroke patients with 10-point ASPECTS. Eur J Neurol 2020; 28:209-219. [PMID: 32924246 DOI: 10.1111/ene.14529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 08/07/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to assess functional and radiological outcomes after bridging therapy (intravenous thrombolysis plus mechanical thrombectomy) versus direct mechanical thrombectomy (MT) in unknown onset stroke patients. METHODS A cohort study was conducted on prospectively collected data from unknown onset stroke patients who received endovascular procedures at ≤6 h from symptom recognition or awakening time. RESULTS Of the 349 patients with a 10-point Alberta Stroke Program Early Computed Tomography Score (ASPECTS), 248 received bridging and 101 received direct MT. Of the 134 patients with 6-9-point ASPECTS, 123 received bridging and 111 received direct MT. Each patient treated with bridging was propensity score matched with a patient treated with direct MT for age, sex, study period, pre-stroke disability, stroke severity, type of stroke onset, symptom recognition to groin time (or awakening to groin time), ASPECTS and procedure time. In the two matched groups with 10-point ASPECTS (n = 73 vs. n = 73), bridging was associated with higher rates of excellent outcome (46.6% vs. 28.8%; odds ratio 2.302, 95% confidence interval 1.010-5.244) and successful recanalization (83.6% vs. 63%; odds ratio 3.028, 95% confidence interval 1.369-6.693) compared with direct MT; no significant association was found between bridging and direct MT with regard to rate of symptomatic intracerebral hemorrhage (0% vs. 1.4%). In the two matched groups with 6-9-point ASPECTS (n = 45 vs. n = 45), no significant associations were found between bridging and direct MT with regard to rates of excellent functional outcome (44.4% vs. 31.1%), successful recanalization (73.3% vs. 76.5%) and symptomatic intracerebral hemorrhage (0% vs. 0%). CONCLUSIONS Bridging at ≤ 6 h of symptom recognition or awakening time was associated with better functional and radiological outcomes in unknown onset stroke patients with 10-point ASPECTS.
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Affiliation(s)
- M Cappellari
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - V Saia
- Santa Corona Hospital, Pietra Ligure, Italy
| | | | | | - R Gandini
- Policlinico Tor Vergata, Roma, Italy
| | - S Nappini
- Careggi University Hospital, Firenze, Italy
| | - P Nencini
- Careggi University Hospital, Firenze, Italy
| | - S Vallone
- Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy
| | - A Zini
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - G Bigliardi
- Ospedale Civile S. Agostino-Estense-University Hospital, Modena, Italy
| | - F Granata
- Policlinico G. Martino, Messina, Italy
| | - F Grillo
- Policlinico G. Martino, Messina, Italy
| | - S Cioni
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - R Tassi
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - M Bergui
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - P Cerrato
- Città della Salute e della Scienza-Molinette, Torino, Italy
| | - A Saletti
- Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - A De Vito
- Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | | | - F Taglialatela
- IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | | | | | | | | | - R Menozzi
- Ospedale Universitario, Parma, Italy
| | | | | | | | - A Comai
- Ospedale Provinciale, Bolzano, Italy
| | | | | | | | - E F M Ciceri
- Fondazione IRCSS-Istituto Neurologico Carlo Besta, Milano, Italy
| | - B Bonetti
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - P Zampieri
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - D Toni
- Sapienza University Hospital, Roma, Italy
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Lozupone E, Bracco S, Trombatore P, Milonia L, D'Argento F, Alexandre A, Valente I, Semeraro V, Cioni S, Pedicelli A. Endovascular treatment of cerebral dural arteriovenous fistulas with SQUID 12. Interv Neuroradiol 2020; 26:651-657. [PMID: 32842833 DOI: 10.1177/1591019920954095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/06/2023] Open
Abstract
BACKGROUND Endovascular therapy with liquid embolic agents (LEAs) is the gold standard for the treatment of cerebral dural arteriovenous fistulas (cDAVFs). The aim of the study is to retrospectively evaluate effectiveness, safety, and midterm follow-up results of endovascular treatment of cDAVFs using SQUID 12. METHODS Between June 2017 and January 2020 the authors retrospectively reviewed clinical, demographic and embolization data of 19 consecutive patients with cDAVF who underwent embolization using SQUID 12. The number of arteries catheterized for each procedure, the total amount of embolic agent, the occlusion rate, the injection time, any technical and/or clinical complications were recorded. Mid-term follow-up with DSA was reviewed. RESULTS 20 procedures were performed in 19 patients. A transarterial approach was accomplished in 19 procedure; a combined transvenous-transarterial approach was realized in 1 treatment. The average time of injection was 33 minutes (2-82 minutes), and the average amount of SQUID 12 was 2.8 mL (0.5-6 mL). Complete angiographic cure at the end of the procedure was achieved in 17 patients. No major periprocedural adverse events were recorded. Mid-term follow-up was achieved in 15 out of 19 patients and confirmed complete occlusion of the cDAVFs in 13/15 patients (87%); in 2 of the initially cured patients a small relapse was detected. CONCLUSIONS The treatment of the cDAVFs using SQUID 12 was effective and safe. The lower viscosity seems to allow an easier penetration of the agent with a high rate of complete occlusion of the cDAVFs.
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Affiliation(s)
- Emilio Lozupone
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Sandra Bracco
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Luca Milonia
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco D'Argento
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Andrea Alexandre
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Iacopo Valente
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - Vittorio Semeraro
- Dipartimento di Diagnostica per Immagini e Radioterapia, SS. Annunziata Hospital, Taranto, Italy
| | - Samuele Cioni
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandro Pedicelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC Radiologia e Neuroradiologia, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
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7
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Cappellari M, Pracucci G, Forlivesi S, Saia V, Limbucci N, Nencini P, Inzitari D, Da Ros V, Sallustio F, Vallone S, Bigliardi G, Zini A, Vinci SL, Dell'Aera C, Bracco S, Cioni S, Tassi R, Bergui M, Naldi A, Carità G, Azzini C, Casetta I, Gasparotti R, Magoni M, Castellan L, Finocchi C, Menozzi R, Scoditti U, Causin F, Viaro F, Puglielli E, Casalena A, Ruggiero M, Biguzzi S, Castellano D, Cavallo R, Lazzarotti GA, Orlandi G, Sgreccia A, Denaro MF, Cavasin N, Critelli A, Ciceri EFM, Bonetti B, Chiumarulo L, Petruzzelli M, Pellegrino C, Carimati F, Burdi N, Prontera MP, Auteri W, Petrone A, Guidetti G, Nicolini E, Ganci G, Sugo A, Filauri P, Sacco S, Squassina G, Invernizzi P, Nuzzi NP, Corato M, Amistà P, Gentile M, Barbero S, Schirru F, Craparo G, Mannino M, Simonetti L, Mangiafico S, Toni D. Direct thrombectomy for stroke in the presence of absolute exclusion criteria for thrombolysis. J Neurol 2020; 267:3731-3740. [PMID: 32712865 DOI: 10.1007/s00415-020-10098-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/15/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intravenous thrombolysis (IVT)-ineligible patients undergoing direct thrombectomy tended to have poorer functional outcome as compared with IVT-eligible patients undergoing bridging therapy. We aimed to assess radiological and functional outcomes in large vessel occlusion-related stroke patients receiving direct thrombectomy in the presence of absolute exclusion criteria for IVT vs relative exclusion criteria for IVT and vs non-exclusion criteria for IVT. METHODS A cohort study on prospectively collected data from 2282 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke cohort for treatment with direct thrombectomy (n = 486, absolute exclusion criteria for IVT alone; n = 384, absolute in combination with relative exclusion criteria for IVT; n = 777, relative exclusion criteria for IVT alone; n = 635, non-exclusion criteria for IVT). RESULTS After adjustment for unbalanced variables (model 1), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.595, 95% CI 1.042-2.440) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.235, 95% CI 1.014-1.504). After adjustment for predefined variables (model 2: age, sex, pre-stroke mRS ≤ 1, NIHSS, occlusion in the anterior circulation, onset-to-groin time, and procedure time), ORs for 3-month death was higher in the presence of absolute exclusion criteria for IVT alone (vs relative exclusion criteria for IVT alone) (1.235, 95% CI 1.014-1.504) and in the presence of absolute exclusion criteria for IVT alone (vs non-exclusion criteria for IVT) (1.246, 95% CI 1.039-1.495). No significant difference was found between the groups as regards any type of intracerebral hemorrhage and parenchymal hematoma within 24 h, successful and complete recanalization after procedure, and modified Rankin Scale score 0-2 at 3 months. After adjustment for predefined variables of model 2, ORs for death were higher in the presence of recent administration of IV heparin (OR: 2.077), platelet count < 100,000/mm3 (OR: 4.798), bacterial endocarditis (OR: 15.069), neoplasm with increased hemorrhagic risk (OR: 6.046), and severe liver disease (OR: 6.124). CONCLUSIONS Radiological outcomes were similar after direct thrombectomy in patients with absolute, relative, and non- exclusion criteria for IVT, while an increase of fatal outcome was observed in the presence of some absolute exclusion criterion for IVT.
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Affiliation(s)
- Manuel Cappellari
- USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy.
| | | | - Stefano Forlivesi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | | | | | | | | | | | - Stefano Vallone
- Ospedale Civile S.Agostino-Estense-University Hospital, Modena, Italy
| | - Guido Bigliardi
- Ospedale Civile S.Agostino-Estense-University Hospital, Modena, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | | | - Sandra Bracco
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Samuele Cioni
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Mauro Bergui
- Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Andrea Naldi
- Città della Salute e della Scienza-Molinette, Turin, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bruno Bonetti
- USD Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Piazzale A. Stefani 1, 37126, Verona, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Pietro Filauri
- Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Simona Sacco
- Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Guido Squassina
- Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | | | | | | | | | - Mauro Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | | | | | | | - Luigi Simonetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
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Cioni S, Casseri T, Vallone IM, Gennari P, Romano DG, Leonini S, Acampa M, Tassi R, Martini G, Bracco S. Letter regarding "Combined aspiration thrombectomy and continuous intrasinus thrombolysis for cerebral venous sinus thrombosis: technical note and case series". Neuroradiology 2019; 61:845-846. [PMID: 31143983 DOI: 10.1007/s00234-019-02232-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Samuele Cioni
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera e Universitaria Senese, Viale Bracci 13, 53100, Siena, SI, Italy
| | - Tommaso Casseri
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera e Universitaria Senese, Viale Bracci 13, 53100, Siena, SI, Italy.
| | - Ignazio M Vallone
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera e Universitaria Senese, Viale Bracci 13, 53100, Siena, SI, Italy
| | - Paola Gennari
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera e Universitaria Senese, Viale Bracci 13, 53100, Siena, SI, Italy
| | - Daniele G Romano
- Neuroradiology Unit, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Sara Leonini
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera e Universitaria Senese, Viale Bracci 13, 53100, Siena, SI, Italy
| | - Maurizio Acampa
- Stroke Unit, Azienda Ospedaliera e Universitaria Senese, Siena, Italy
| | - Rossana Tassi
- Stroke Unit, Azienda Ospedaliera e Universitaria Senese, Siena, Italy
| | - Giuseppe Martini
- Stroke Unit, Azienda Ospedaliera e Universitaria Senese, Siena, Italy
| | - Sandra Bracco
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera e Universitaria Senese, Viale Bracci 13, 53100, Siena, SI, Italy
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Cappellari M, Mangiafico S, Saia V, Pracucci G, Nappini S, Nencini P, Konda D, Sallustio F, Vallone S, Zini A, Bracco S, Tassi R, Bergui M, Cerrato P, Pitrone A, Grillo F, Saletti A, De Vito A, Gasparotti R, Magoni M, Puglielli E, Casalena A, Causin F, Baracchini C, Castellan L, Malfatto L, Menozzi R, Scoditti U, Comelli C, Duc E, Comai A, Franchini E, Cosottini M, Mancuso M, Peschillo S, De Michele M, Giorgianni A, 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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Romano DG, Cioni S, Leonini S, Gennari P, Vallone IM, Zandonella A, Puliti A, Tassi R, Casasco A, Martini G, Bracco S. Manual thromboaspiration technique as a first approach for endovascular stroke treatment: A single-center experience. Interv Neuroradiol 2016; 22:529-34. [PMID: 27301390 DOI: 10.1177/1591019916653256] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 05/15/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For intracranial large vessel occlusion in acute ischemic stroke (AIS), a high degree of revascularization in the minimal amount of time predicts good outcomes. Recently, different studies have shown that the direct aspiration first pass technique (ADAPT technique) for AIS obtains high recanalization rates, fast interventions and low costs when it works as first attempt. This study retrospectively describes revascularization efficacy, duration of procedure, intra and post-procedural complications, early and after 90-days clinical outcome in a group of patients who underwent ADAPT as the primary endovascular approach, eventually followed by stent retriever thrombectomy, for recanalization of large vessels in the anterior circulation. MATERIALS AND METHODS We analyzed clinical and procedural data of patients treated from April 2014 to August 2015. Recanalization was assessed according to the Thrombolysis in Cerebral Infarction score. Clinical outcome was evaluated at discharge and after 3 months (modified Rankin Scale, mRS). RESULTS Overall, 71 patients (mean age of 69.7 years) were treated. Sites of occlusion were anterior circulation (including seven tandem extracranial-intracranial occlusions). In 39 patients i.v. rtPA was attempted. Recanalization of the target vessel was obtained in 87.3% of cases whereas direct aspiration alone was successful in 46/71cases (64.8%) with an average puncture-to-revascularization time of 43.1 minutes. Symptomatic intracranial hemorrhage occurred in 7.8% and embolization to new territories in 5.6%. In total, 38 patients (53.5%) had a good outcome at 90 days follow-up. CONCLUSIONS In our series, the manual thromboaspiration technique has been shown as fast and safe, with good rates of vessel revascularization in 87.3% of patients and neurological outcome <3 mRS in 53.5% of patients.
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Affiliation(s)
- D G Romano
- Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - S Cioni
- Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - S Leonini
- Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - P Gennari
- Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - I M Vallone
- Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - A Zandonella
- Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - A Puliti
- Department of Human Pathology and Oncology, Section of Radiological Science, University of Siena, Siena, Italy
| | - R Tassi
- Department of Neurological and Sensorineural Sciences, Stroke Unit, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - A Casasco
- Unit of Endovascular and Percutaneous Therapy, Clinica Nuestra Senora del Rosario, Madrid, Spain
| | - G Martini
- Department of Neurological and Sensorineural Sciences, Stroke Unit, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - S Bracco
- Department of Neurological and Sensorineural Sciences, Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italy
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Romano DG, Cioni S, Vinci SL, Pero G, Comelli C, Comai A, Peschillo S, Mardighian D, Castellan L, Resta F, Piano MG, Comelli S, Barletta L, Puliti A, Leonini S, Bracco S. Thromboaspiration technique as first approach for endovascular treatment of acute ischemic stroke: initial experience at nine Italian stroke centers. J Neurointerv Surg 2016; 9:6-10. [PMID: 26984869 DOI: 10.1136/neurintsurg-2016-012298] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 02/25/2016] [Accepted: 02/26/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Aspiration thrombectomy of large vessel occlusions has made a comeback among recanalization techniques thanks to recent advances in catheter technology resulting in faster recanalization and promising clinical results when used either alone or as an adjunct to stent retriever. This multicenter retrospective study reports angiographic data, complications, and clinical outcome in patients treated with aspiration thrombectomy as the first-line option. MATERIALS AND METHODS We analysed the clinical and procedural data of patients treated from January 2014 to March 2015. Recanalization was assessed according to the Thrombolysis in Cerebral Infarction score. Clinical outcome was evaluated at discharge and after 3 months. RESULTS Overall, 152 patients (mean age 68 years) were treated. Sites of occlusion were 90.8% anterior circulation (including 16.4% tandem extracranial/intracranial occlusions) and 9.2% basilar artery. In 79 patients administration of intravenous tissue plasminogen activator was attempted. Recanalization of the target vessel was obtained in 115/152 cases (75.6%) whereas direct aspiration alone was successful in 83/152 cases (54.6%) with an average puncture to revascularization time of 44.67 min. Symptomatic intracranial hemorrhage occurred in 7.8% and embolization to new territories in 1.9%. 77 patients (50.6%) had a good outcome at 90-day follow-up: 55/96 in the direct aspiration alone group and 22/56 in the aspiration-stent retriever group. CONCLUSIONS Direct aspiration thrombectomy appears a feasible technique with good revascularization results achieved in more than half the patients. In light of the self-reported data, inhomogeneous patient selection, absence of a core imaging laboratory, and a non-standardized approach, the results should be validated in a larger trial.
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Affiliation(s)
- D G Romano
- Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy
| | - S Cioni
- Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy
| | - S L Vinci
- Neuroradiology Unit, Department of Radiological Sciences, University of Messina, Messina, Italy
| | - G Pero
- Neuroradiology Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - C Comelli
- Department of Interventional Radiology and Neuroradiology, S. Giovanni Bosco Emergencies Hospital, Turin, Italy
| | - A Comai
- Department of Radiology, Central Hospital of Bolzano, Italy
| | - S Peschillo
- Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, "Sapienza" University of Rome, Rome, Italy
| | - D Mardighian
- Department of Neuroradiology, Spedali Civili, University of Brescia, Italy
| | - L Castellan
- Neuroradiology Unit, San Martino Hospital-IST-IRCCS, Genoa, Italy
| | - F Resta
- Department of Cardiology, University of Bari, Bari, Italy
| | - M G Piano
- Neuroradiology Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - S Comelli
- Department of Interventional Radiology and Neuroradiology, S. Giovanni Bosco Emergencies Hospital, Turin, Italy
| | - L Barletta
- Neuroradiology Unit, San Martino Hospital-IST-IRCCS, Genoa, Italy
| | - A Puliti
- Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy
| | - S Leonini
- Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy
| | - S Bracco
- Department of Neurological Sciences, Division of Diagnostic and Interventional Neuroradiology, University Hospital of Siena, Italy
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Fantini L, Iovino P, Polidori C, Boriani F, Cioni S, Trombetta L, Sassoli V. CP-156 Prescribing pattern, tolerability and efficacy study (4 weeks) of the novel drug ‘xiapex’. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.156] [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: 11/04/2022] Open
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Bertelli E, Leonini S, Galimberti D, Moretti S, Tinturini R, Hadjistilianou T, De Francesco S, Romano DG, Vallone IM, Cioni S, Gennari P, Galluzzi P, Grazzini I, Rossi S, Bracco S. Hemodynamic and Anatomic Variations Require an Adaptable Approach during Intra-Arterial Chemotherapy for Intraocular Retinoblastoma: Alternative Routes, Strategies, and Follow-Up. AJNR Am J Neuroradiol 2016; 37:1289-95. [PMID: 26915566 DOI: 10.3174/ajnr.a4741] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/09/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Intra-arterial chemotherapy for retinoblastoma is not always a straightforward procedure, and it may require an adaptable approach. This study illustrates strategies used when the ophthalmic artery is difficult to catheterize or not visible, and it ascertains the effectiveness and safety of these strategies. MATERIALS AND METHODS A retrospective study was performed on a series of 108 eyes affected by intraocular retinoblastoma and selected for intra-arterial chemotherapy (follow-up range, 6-82 months). We recognized 3 different patterns of drug delivery: a fixed pattern through the ophthalmic artery, a fixed pattern through branches of the external carotid artery, and a variable pattern through either the ophthalmic or the external carotid artery. RESULTS We performed 448 sessions of intra-arterial chemotherapy, 83.70% of them through the ophthalmic artery and 16.29% via the external carotid artery. In 24.52% of eyes, the procedure was performed at least once through branches of the external carotid artery. In 73 eyes, the pattern of drug delivery was fixed through the ophthalmic artery; for 9 eyes, it was fixed through branches of the external carotid artery; and for 17 eyes, the pattern was variable. Statistical analysis did not show any significant difference in the clinical outcome of the eyes (remission versus enucleation) treated with different patterns of drug delivery. Adverse events could not be correlated with any particular pattern. CONCLUSIONS Alternative routes of intra-arterial chemotherapy for intraocular retinoblastoma appear in the short term as effective and safe as the traditional drug infusion through the ophthalmic artery.
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Affiliation(s)
- E Bertelli
- From the Department of Molecular and Developmental Medicine (E.B., S.R.), University of Siena, Siena, Italy
| | - S Leonini
- Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.)
| | | | | | - R Tinturini
- Neurosurgical Intensive Care (R.T.), Azienda Ospedaliera Universitaria Senese, University of Siena, Policlinico "Santa Maria alle Scotte," Siena, Italy
| | - T Hadjistilianou
- Department of Medicine, Surgery and Neuroscience (T.H., S.D.F.), Unit of Ophthalmology, University of Siena, Policlinico "Santa Maria alle Scotte," Siena, Italy
| | - S De Francesco
- Department of Medicine, Surgery and Neuroscience (T.H., S.D.F.), Unit of Ophthalmology, University of Siena, Policlinico "Santa Maria alle Scotte," Siena, Italy
| | - D G Romano
- Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.)
| | - I M Vallone
- Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.)
| | - S Cioni
- Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.)
| | - P Gennari
- Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.)
| | - P Galluzzi
- Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.)
| | - I Grazzini
- Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.)
| | - S Rossi
- From the Department of Molecular and Developmental Medicine (E.B., S.R.), University of Siena, Siena, Italy
| | - S Bracco
- Units of Neuroimaging and Neurointervention (S.L., D.G.R., I.M.V., S.C., P. Gennari, P. Galluzzi, I.G., S.B.)
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Bracco S, Venturi C, Leonini S, Romano DG, Cioni S, Vallone IM, Gennari P, Hadjistilianou T, De Francesco S, Bertelli E. Transorbital anastomotic pathways between the external and internal carotid systems in children affected by intraocular retinoblastoma. Surg Radiol Anat 2015. [PMID: 26198114 DOI: 10.1007/s00276-015-1519-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE It is well known that many anastomoses can join the external carotid system and the ophthalmic artery. However, their frequency has never been reported. Since they can be relevant for interventional radiologists operating in the orbit, we decided to illustrate and determine the frequency of the anastomoses that can be found in children. METHODS A retrospective study of 443 angiographic procedures (via ophthalmic artery and/or external carotid artery) carried out on 97 children affected by intraocular retinoblastoma was made to investigate the arterial anatomy of 106 orbits. RESULTS Anastomoses were observed in 44.33 % of orbits. However, their true frequency is likely much higher as the rate of visualization increased up to 91.11 % of orbits when the angiographic study was extended to the external carotid artery. In order of frequency we detected the following anastomoses: lacrimal artery-middle meningeal artery, lacrimal artery-anterior deep temporal artery, ophthalmic artery-middle meningeal artery, ophthalmic artery-facial artery, supraorbital artery-superficial temporal artery, supratrochlear artery-superficial temporal artery, supraorbital artery-middle meningeal artery, dorsal nasal artery-infraorbital artery, supraorbital artery-zygomaticoorbital artery, lacrimal artery-zygomaticoorbital artery. CONCLUSION When properly searched, anastomoses between the ophthalmic artery and the external carotid artery are almost constant in children. Depending on the clinical scenario, they can represent dangers or valuable alternative routes for collateral circulations and intraarterial chemotherapy.
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Affiliation(s)
- Sandra Bracco
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Carlo Venturi
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Sara Leonini
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Daniele G Romano
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Samuele Cioni
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Ignazio M Vallone
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Paola Gennari
- Unit of Neuroimaging and Neurointervention (NINT), Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Theodora Hadjistilianou
- Department of Medicine, Surgery and Neuroscience, Unit of Ophthalmology, University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
- Referral Center for Retinoblastoma, University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Sonia De Francesco
- Referral Center for Retinoblastoma, University of Siena, Policlinico "Santa Maria alle Scotte", Siena, Italy
| | - Eugenio Bertelli
- Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100, Siena, Italy.
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Bracco S, Venturi C, Leonini S, Romano DG, Cioni S, Vallone IM, Gennari P, Galluzzi P, Hadjistilianou T, De Francesco S, Guglielmucci D, Tarantino F, Bertelli E. Identification of Intraorbital Arteries in Pediatric Age by High Resolution Superselective Angiography. Orbit 2015; 34:237-47. [PMID: 26154349 DOI: 10.3109/01676830.2015.1049368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Angiography is a powerful tool to identify intraorbital arteries. However, the incidence by which these vessels can be identified is unknown. Our purpose was to determine such incidence and which angiographic approach is best for the identification of each artery. METHODS A retrospective study of 353 angiographic procedures (via ophthalmic artery and/or external carotid artery) carried out on 79 children affected by intraocular retinoblastoma was made to investigate the arterial anatomy in 87 orbits. For each intraorbital artery two parameters were calculated: the angiographic incidence, as the percentage of times a given artery was identified, and the visibility index, as the ratio between the angiographic incidence and the true anatomic incidence. RESULTS All collaterals of the ophthalmic artery could be spotted. Most of them were identified with a high angiographic incidence; some of them were less easily identified because too thin or because frequently shielded. The visibility index paralleled the angiographic incidence of most arteries. However, the lacrimal and meningolacrimal arteries had a higher visibility index suggesting that their identification was more frequent than the angiographic incidence alone could suggest. Statistical analysis demonstrated that the lacrimal artery and some muscular branches had higher chances to be identified if the angiography of the ophthalmic artery was accompanied by the study of the external carotid system. CONCLUSION This work provides an objective measure of how powerful angiography is to identify intraorbital arteries as well as useful references for professionals who need to operate in the orbit.
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Affiliation(s)
- Sandra Bracco
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Carlo Venturi
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Sara Leonini
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Daniele G Romano
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Samuele Cioni
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Ignazio M Vallone
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Paola Gennari
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Paolo Galluzzi
- a Unit of Neuroimaging and Neurointervention (NINT) , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Theodora Hadjistilianou
- b Department of Medicine , Surgery and Neuroscience, Unit of Ophthalmology, University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy .,c Referral Center for Retinoblastoma, University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Sonia De Francesco
- c Referral Center for Retinoblastoma, University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Daria Guglielmucci
- d Unit of Pediatrics , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy
| | - Francesca Tarantino
- e Unit of Neurosurgical Intensive Care , Azienda Ospedaliera Universitaria Senese (AOUS), University of Siena , Policlinico "Santa Maria alle Scotte," Siena , Italy , and
| | - Eugenio Bertelli
- f Department of Life Sciences , University of Siena , Siena , Italy
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Monti L, Donati D, Menci E, Cioni S, Bellini M, Grazzini I, Leonini S, Galluzzi P, Severi S, Burroni L, Casasco A, Morbidelli L, Santarnecchi E, Piu P. Cerebral circulation time is prolonged and not correlated with EDSS in multiple sclerosis patients: a study using digital subtracted angiography. PLoS One 2015; 10:e0116681. [PMID: 25679526 PMCID: PMC4334558 DOI: 10.1371/journal.pone.0116681] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/13/2014] [Indexed: 12/23/2022] Open
Abstract
Literature has suggested that changes in brain flow circulation occur in patients with multiple sclerosis. In this study, digital subtraction angiography (DSA) was used to measure the absolute CCT value in MS patients and to correlate its value to age at disease onset and duration, and to expand disability status scale (EDSS). DSA assessment was performed on eighty MS patients and on a control group of forty-four age-matched patients. CCT in MS and control groups was calculated by analyzing the angiographic images. Lesion and brain volumes were calculated in a representative group of MS patients. Statistical correlations among CCT and disease duration, age at disease onset, lesion load, brain volumes and EDSS were considered. A significant difference between CCT in MS patients (mean = 4.9s; sd = 1.27s) and control group (mean = 2.8s; sd = 0.51s) was demonstrated. No significant statistical correlation was found between CCT and the other parameters in all MS patients. Significantly increased CCT value in MS patients suggests the presence of microvascular dysfunctions, which do not depend on clinical and MRI findings. Hemodynamic changes may not be exclusively the result of a late chronic inflammatory process.
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Affiliation(s)
- Lucia Monti
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
- * E-mail:
| | - Donatella Donati
- Dept. of Medicine, Surgery & Neuroscience, University of Siena, Siena, Italy
| | - Elisabetta Menci
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Samuele Cioni
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Matteo Bellini
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Irene Grazzini
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Sara Leonini
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Paolo Galluzzi
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Sensorial Sciences Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Sauro Severi
- Dept. of Neurology, General Hospital of “S. Donato d’Arezzo”, Arezzo, Italy
| | - Luca Burroni
- Unit of Nuclear Medicine, Azienda Ospedaliera Universitaria Senese, Santa Maria alle Scotte General Hospital, Siena, Italy
| | - Alfredo Casasco
- Unit of Endovascular and Percutaneous Therapy, Clinica Nuestra Senora del Rosario, Madrid, Spain
| | | | - Emiliano Santarnecchi
- Dept. of Medicine, Surgery & Neuroscience, University of Siena, Siena, Italy
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Pietro Piu
- Dept. of Medicine, Surgery & Neuroscience, University of Siena, Siena, Italy
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Bracco S, Leonini S, De Francesco S, Cioni S, Gennari P, Vallone IM, Piu P, Galimberti D, Romano DG, Caini M, De Luca M, Toti P, Galluzzi P, Hadjistilianou T, Cerase A. Intra-arterial chemotherapy with melphalan for intraocular retinoblastoma. Br J Ophthalmol 2013; 97:1219-21. [PMID: 23853166 DOI: 10.1136/bjophthalmol-2013-303267] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Venturi C, Bracco S, Cerase A, Cioni S, Galluzzi P, Gennari P, Vallone IM, Tinturini R, Vittori C, De Francesco S, Caini M, D'Ambrosio A, Toti P, Renieri A, Hadjistilianou T. Superselective ophthalmic artery infusion of melphalan for intraocular retinoblastoma: preliminary results from 140 treatments. Acta Ophthalmol 2013; 91:335-42. [PMID: 22268993 DOI: 10.1111/j.1755-3768.2011.02296.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [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: 11/30/2022]
Abstract
PURPOSE To report our experience in superselective ophthalmic artery infusion of melphalan (SOAIM) for intraocular retinoblastoma. METHODS From June 2008 to October 2010, 38 patients (18 women, 20 men; age range at first treatment, 7 months to 22 years) with 41 eyes with retinoblastoma were scheduled for SOAIM, for 17 newly diagnosed retinoblastomas Tumour, Node and Metastasis (TNM) 7th Edition 1a (n = 1), 1b (n = 1), 2a (n = 7), 2b (n = 4) and 3a (n = 4) and 24 retinoblastomas with partial remission/relapse TNM 7th Edition 1b (n = 13), 2a (n = 1) and 2b (n = 10). Eight patients (ten eyes) have been treated by SOAIM alone. Follow-up was 6-27 months in 28 patients (30 eyes). RESULTS Ophthalmic artery cannulation failed in two patients. Thirty-six patients underwent 140 treatments by internal (n = 112) or external (n = 28) carotid arteries. No major procedural complications occurred. Two patients have been lost to follow-up. Remaining 34 patients (37 eyes) had no metastatic disease. Four patients suffered permanent ocular complications: chorioretinal dystrophy (n = 2), ptosis (n = 1) and strabismus/exotropia (n = 1). Eight (22%) eyes in eight (24%) patients underwent enucleation: 7/16 (43%) newly diagnosed retinoblastomas and 1/22 (4.5%) retinoblastomas undergoing partial remission/relapse. For all treated eyes, Kaplan-Meier eye enucleation-free rates (K-M) were 85.4% (95% CI, 73.3-97.5%), 74.4% (95% CI, 57-91.8%) and still stable at 6, 12 months and 2 years, respectively. For eyes with partial remission/relapse, and eyes at presentation, K-M at 2 years were 95.5% (95% CI, 86.9-100%) and 45.6% (95% CI, 16.6-74.6%), respectively. CONCLUSION Superselective ophthalmic artery infusion of melphalan was safe and powerful, especially following other therapies. Superselective ophthalmic artery infusion of melphalan should be added to focal therapies spectrum. In selected cases, melphalan should be combined with other chemotherapeutic agents.
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Affiliation(s)
- Carlo Venturi
- Unit NINT Neuroimaging and Neurointervention, Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy.
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Tassi R, Acampa M, Marotta G, Cioni S, Guideri F, Rossi S, Cerase A, Martini G. Systemic thrombolysis for stroke in pregnancy. Am J Emerg Med 2012; 31:448.e1-3. [PMID: 22867835 DOI: 10.1016/j.ajem.2012.05.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022] Open
Affiliation(s)
- Rossana Tassi
- Department of Neurological and Sensorineural Sciences, Azienda Ospedaliera Universitaria Senese, Policlinico Santa Maria alle Scotte, Siena, Italy
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Cerase A, Lazzeretti L, Vallone IM, Ferretti F, Bracco S, Galluzzi P, Gennari P, Monti L, Menci E, Bellini M, Arrigucci U, Cioni S, Romano D, Sanna A, Zandonella A, Acampa M, Tassi R, Martini G, Venturi C. [Neuroimaging and definition of transient ischemic attack]. Minerva Med 2012; 103:299-311. [PMID: 22805622] [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: 06/01/2023]
Abstract
AIM Transient ischemic attack (TIA) has to be considered an "alarm bell" of a more or less severe organic or systemic vasculopathy. Positive findings at neuroimaging means tissue damage. The purpose of this retrospective study was to assess the role of neuroimaging in the management of patients presenting with TIA, and to consider the relative implications. METHODS In a consecutive series of 82 patients (53 males, 29 females, mean age: 65.9±13.1 years) admitted for TIA, it was possible to review the history and the clinical data of 66 patients, including ABCD2 score, laboratory including plasmatic D-dimer, and neuroimaging data including computed tomography (CT) and magnetic resonance imaging including diffusion-weighted with apparent diffusion coefficient measure (DWI-ADC) obtained at diagnosis and by a week later (16 by CT, and 50 by DWI-ADC). Thirty-three patients underwent DWI-ADC within 24 hours from symptoms onset. Statistical analysis has been performed by non-parametric tests (χ2 and Mann-Whitney), and logistic regression by a commercially available software. RESULTS CT and/or DWI-ADC showed signs of acute ischemic lesions in 23/66 (35%) patients. 12 out of the 35 patients with a 24-hour DWI-ADC follow-up were positive. Statistical analysis showed that positive neuroimaging was significantly associated only with familial history of cardiovascular diseases (P<0.012) and previous TIA/stroke (P<0.046). CONCLUSION In this patients series, at least 35% of patients with TIA had a positive neuroimaging, especially DWI-ADC. Positive neuroimaging seems an independent factor. Patients with TIA need an early assessment by neuroimaging including DWI-ADC, in order to obtain a correct classification and prognosis.
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Affiliation(s)
- A Cerase
- UOC NINT Neuroimmagini e Neurointerventistica, Dipartimento di Scienze Neurologiche e Neurosensoriali, Azienda Ospedaliera Universitaria Senese, Policlinico "Santa Maria alle Scotte", Siena, Italia.
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Cioni S, Chaumat S, Sommeria J. Effect of a vertical magnetic field on turbulent rayleigh-Benard convection. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 2000; 62:R4520-R4523. [PMID: 11089073 DOI: 10.1103/physreve.62.r4520] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2000] [Indexed: 05/23/2023]
Abstract
The effect of a vertical uniform magnetic field on Rayleigh-Benard convection is investigated experimentally. We confirm that the threshold of convection is in agreement with linear stability theory up to a Chandrasekhar number Q approximately 4x10(6), higher than in previous experiments. We characterize two convective regimes influenced by MHD effects. In the first one, the Nusselt number Nu proportional to the Rayleigh number Ra, which can be interpreted as a condition of marginal stability for the thermal boundary layer. For higher Ra, a second regime Nu approximately Ra0.43 is obtained.
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Affiliation(s)
- S Cioni
- Ecole Normale Superieure de Lyon, Laboratoire de Physique, CNRS URA1325, 46, Allee d'Italie, 69364 Lyon Cedex 07, France
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Ciliberto S, Cioni S, Laroche C. Large-scale flow properties of turbulent thermal convection. Phys Rev E Stat Phys Plasmas Fluids Relat Interdiscip Topics 1996; 54:R5901-R5904. [PMID: 9965941 DOI: 10.1103/physreve.54.r5901] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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