Carotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke Fabrizio Sallustio, Giovanni Pracucci, Manuel Cappellari, Valentina Saia, Alfredo Paolo Mascolo, Federico Marrama, Roberto Gandini, Giacomo Koch, Marina Diomedi, Federica D’Agostino, Alessandro Rocco, Valerio Da Ros, Andrea Wlderk, Marco Nezzo, Renato Argirò, Daniele Morosetti, Leonardo Renieri, Patrizia Nencini, Stefano Vallone, Andrea Zini, Guido Bigliardi, Antonio Pitrone, Francesco Grillo, Sandra Bracco, Rossana Tassi, Mauro Bergui, Andrea Naldi, Giuseppe Carità, Ilaria Casetta, Roberto Gasparotti, Mauro Magoni, Luigi Simonetti, Nicolò Haznedari, Matteo Paolucci, Nicola Mavilio, Laura Malfatto, Roberto Menozzi, Antonio Genovese, Mirco Cosottini, Giovanni Orlandi, Alessio Comai, Enrica Franchini, Alessandro Pedicelli, Giovanni Frisullo, Edoardo Puglielli, Alfonsina Casalena, Giacomo Cester, Claudio Baracchini, Davide Castellano, Alessandra Di Liberto, Giuseppe Kenneth Ricciardi, Luigi Chiumarulo, Marco Petruzzellis, Elvis Lafe, Alessandra Persico, Nicola Cavasin, Adriana Critelli, Vittorio Semeraro, Angelica Tinelli, Andrea Giorgianni, Federico Carimati, William Auteri, Stefano Rizzuto, Francesco Biraschi, Ettore Nicolini, Antonio Ferrari, Maurizio Melis, Stefano Calia, Tiziana Tassinari, Nunzio Paolo Nuzzi, Manuel Corato, Simona Sacco, Guido Squassina, Paolo Invernizzi, Ivan Gallesio, Luigi Ruiz, Giovanni Dui, Nicola Carboni, Pietro Amistà, Monia Russo, Mario Maiore, Bastianina Zanda, Giuseppe Craparo, Marina Mannino, Domenico Inzitari, Danilo Toni, Salvatore Mangiafico, R. Gasparotti, D. Inzitari, S. Mangiafico, D. Toni, S. Vallone, A. Zini, M. Bergui, F. Causin, A. Ciccone, P. Nencini, A. Saletti, F. Sallustio, R. Tassi, F. Zappoli Thyrion, G. Pracucci, V. Saia, R. Gandini, V. Da Ros, L. Greco, D. Morosetti, M. Diomedi, F. Sallustio, S. Mangiafico, S. Nappini, N. Limbucci, L. Renieri, E. Fainardi, D. Inzitari, P. Nencini, S. Vallone, L. Verganti, F. Sacchetti, G. Zelent, G. Bigliardi, M. L. Dell’Acqua, L. Picchetto, L. Vandelli, R. Pentore, S. Maffei, P. Nichelli, M. Longo, A. Pitrone, S. L. Vinci, M. Velo, A. Caragliano, A. Tessitore, O. Bonomo, R. Musolino, P. La Spina, C. Casella, M. C. Fazio, F. Grillo, M. Cotroneo, C. Dell’Aera, I. Francalanza, S. Bracco, S. Cioni, P. Gennari, I. M. Vallone, A. Cerase, R. Tassi, G. Martini, M. Bergui, G. Stura, D. Daniele, P. Cerrato, A. Naldi, A. Saletti, M. Onofrio, A. De Vito, C. Azzini, I. Casetta, R. Gasparotti, D. Mardighian, M. Frigerio, M. Magoni, A. Costa, L. Simonetti, L. Cirillo, F. Taglialatela, S. Isceri, C. Princiotta, M. Dall’Olio, M. Cellerini, A. Zini, M. Gentile, L. Piccolo, L. Migliaccio, L. Brancaleoni, F. Naldi, M. Romoli, A. Zaniboni, M. Ruggiero, A. Sanna, N. Haznedari, C. Commodaro, M. Longoni, S. Biguzzi, F. Cordici, E. Malatesta, L. Castellan, N. Mavilio, G. Salsano, L. Malfatto, C. Finocchi, R. Menozzi, P. Piazza, E. Epifani, A. Andreone, U. Scoditti, P. Castellini, L. Latte, I. Grisendi, M. Cosottini, M. Puglioli, G. Lazzarotti, D. Lauretti, M. Mancuso, N. Giannini, M. Maccarone, G. Orlandi, A. Comai, G. Bonatti, G. Nano, F. Ferro, M. Bonatti, E. Dall’Ora, R. Currò Dossi, E. Turri, M. Turri, C. Colosimo, A. Pedicelli, F. D’Argento, A. Alexandre, G. Frisullo, V. Di Egidio, E. G. Puglielli, L. Ruggero, M. Assetta, A. Casalena, F. Causin, G. Cester, C. Baracchini, F. Viaro, A. Pieroni, G. Vaudano, C. Comelli, L. Di Maggio, D. Castellano, R. Cavallo, E. Duc, G. Chianale, E. F. M. Ciceri, M. Plebani, R. Augelli, P. Zampieri, A. Grazioli, M. Cappellari, S. Forlivesi, G. Tomelleri, N. Micheletti, L. Chiumarulo, D. S. Zimatore, F. Federico, M. Petruzzelli, F. Zappoli, E. Lafe, G. Sanfilippo, A. Sgreccia, A. Martignoni, A. Cavallini, F. Denaro, A. Persico, E. Cagliari, N. Cavasin, R. Quatrale, A. Critelli, N. Burdi, V. Semeraro, N. Lucarelli, M. P. Ganimede, S. Internò, A. Tinelli, M. P. Prontera, A. Pesare, E. Cotroneo, E. Pampana, F. Ricciardi, R. Gigli, F. R. Pezzella, F. Corsi, A. Giorgianni, F. Baruzzi, C. Pellegrino, A. Terrana, M. Versino, M. L. Delodovici, F. Carimati, L. Princiotta Cariddi, W. Auteri, O. Di Benedetto, U. Silvagni, P. Perrotta, E. Crispino, A. Petrone, F. Stancati, S. Rizzuto, P. Pugliese, E. Pisani, A. Siniscalchi, C. Gaudiano, D. Pirritano, F. Del Giudice, M. Piano, E. Agostoni, C. Motto, A. Gatti, A. Guccione, R. Tortorella, A. Stecco, G. Guzzardi, B. Del Sette, L. Coppo, J. Baldan, D. Romano, A. Siani, G. Locatelli, R. Saponiero, R. Napolitano, M. De Gregorio, G. Volpe, M. Tenuta, G. Guidetti, F. Biraschi, A. Wulbek, D. Toni, A. Falcou, A. Anzini, A. Mancini, M. De Michele, S. Fausti, M. T. Di Mascio, L. Durastanti, E. Sbardella, V. Mellina, E. Nicolini, S. Comelli, C. Ganau, S. Corraine, F. Fusaro, A. Ferrari, F. Schirru, V. Ledda, S. Secci, M. Melis, V. Piras, J. Moller, R. Padolecchia, L. Allegretti, V. Caldiera, S. Calia, G. Ganci, T. Tassinari, V. Saia, A. Sugo, M. De Nicola, M. Giannoni, S. Bruni, E. Gambelli, L. Provinciali, N. P. Nuzzi, S. Marcheselli, M. Corato, F. Scomazzoni, F. Simionato, L. Roveri, P. Filauri, S. Sacco, B. Orlandi, F. De Santis, C. Tiseo, F. Notturno, R. Ornello, M. Pavia, G. Squassina, M. Cobelli, M. Morassi, E. Magni, P. Invernizzi, F. Pepe, B. Bigni, P. Costa, M. Crabbio, S. Griffini, F. Palmerini, M. P. Piras, I. Gallesio, S. Barbero, D. Ferrandi, G. Dui, M. C. Fancello, S. Zedda, A. Ticca, M. V. Saddi, G. Deiana, R. Rossi, N. Carboni, A. Mela, P. Amistà, M. Russo, M. Gentile, G. Iannucci, V. Pinna, L. Di Clemente, M. Santi, A. De Boni, C. De Luca, M. Natrella, G. Fanelli, M. Cristoferi, E. Bottacchi, G. Corso, P. Tosi, M. Sessa, A. Giossi, Baietti, G. Romano, P. Meineri, A. Armentano, P. Versace, L. Arcudi, G. Galvano, B. Petralia, P. Feraco, G. Luppi, B. Giometto, V. Bignamini, S. Piffer, G. B. Meloni, C. Fabio, M. Maiore, F. Pintus, A. Pischedda, A. Manca, C. Mongili, B. Zanda, A. Sanna, A. Baule, F. Florio, G. Ciccarese, M. Leone, P. Di Viesti, M. P. Pappalardo, G. Craparo, C. Gallo, S. Monaco, M. Mannino, M. Muto, GL. Guarnieri, V. Andreone, G. Passalacqua, M. Allegritti, C. Colosimo, S. Caproni, M. Filizzolo, A. Salmaggi, A. Giordano, C. Marini, S. Sacco, I. Frattale, G. Lucente, C. Nozzoli, F. A. Lupo, and Acta Neurologica Belgica, 2023
Repeated reperfusion treatment in recurrent ischemic stroke: A retrospective single-center case series Cristina Dell'Aera, Fabrizio Giammello, Antonio Armando Caragliano, Antonio Ciacciarelli, Isabella Francalanza, Carmelo Tiberio Currò, Antonio Pitrone, Francesco Grillo, Carmela Casella, Maria Carolina Fazio, Paolino La Spina, Masina Cotroneo, Pasquale Crea, Antonio Toscano, Sergio Lucio Vinci, Rosa Fortunata Musolino Journal of the Neurological Sciences, 2022
Variants of the circle of Willis in ischemic stroke patients Jolanda De Caro, Antonio Ciacciarelli, Agostino Tessitore, Orazio Buonomo, Andrea Calzoni, Isabella Francalanza, Cristina Dell’Aera, Domenico Cosenza, Carmelo Tiberio Currò, Francesca Granata, Sergio Lucio Vinci, Giuseppe Trimarchi, Antonio Toscano, Rosa Fortunata Musolino, Paolino La Spina Journal of Neurology, 2021 We aim to provide prevalence and pattern of anatomical variants of circle of Willis in over one thousand ischemic stroke patients compared to an age- and sex-matched control group, and to determine their role in the severity and in-hospital prognosis. Two groups of neuroradiologists evaluated all vascular images of ischemic stroke patients and controls to identify anatomical variants using a preexisted classification. We collected data concerning patient characteristics, stroke severity on admission and discharge, in-hospital mortality, hemorrhagic transformation, acute treatment performed, and etiology. We included 1131 patients with acute ischemic stroke and 562 controls. Among stroke patients, 702 (62.1%) had one or more vascular variants, compared to 308 (54.8%) of the control group (p < 0.01), 165/702 (23.5%) had an anterior circulation variant only, 384/702 (54.7%) had a posterior circulation variant only, and 153/702 (21.8%) patients had variants in both anterior and posterior circulation. Patients with variants were older (69.7 ± 13.9 years vs 72.0 ± 12.9 years; p = 0.039). The most prevalent variant was the agenesis/hypoplasia of the ACA (201/1131; 17.8%) followed by the unilateral fetal type of the PCA (137/1131; 12.11%). We provided the prevalence and the pattern of the brain vascular variants of the circle of Willis in a cohort of patients with ischemic stroke. The prevalence of variants was higher in stroke patients compared to controls. Patients with variants were older but had no differences in sex, neurological admission severity, hemorrhagic transformation, etiology, and in-hospital outcome compared to patients with a typical circle of Willis.
Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke Giancarlo Salsano, Giovanni Pracucci, Nicola Mavilio, Valentina Saia, Monica B di Poggio, Laura Malfatto, Fabrizio Sallustio, Andrea Wlderk, Nicola Limbucci, Patrizia Nencini, Stefano Vallone, Andrea Zini, Guido Bigliardi, Mariano Velo, Isabella Francalanza, Paola Gennari, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Giuseppe Carità, Cristiano Azzini, Roberto Gasparotti, Mauro Magoni, Salvatore Isceri, Christian Commodaro, Francesco Cordici, Roberto Menozzi, Lilia Latte, Mirco Cosottini, Michelangelo Mancuso, Alessio Comai, Enrica Franchini, Andrea Alexandre, Giacomo Della Marca, Edoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Luca Di Maggio, Andrea Naldi, Andrea Grazioli, Stefano Forlivesi, Luigi Chiumarulo, Marco Petruzzellis, Giuseppina Sanfilippo, Gianpaolo Toscano, Nicola Cavasin, Critelli Adriana, Maria Porzia Ganimede, Maria Pia Prontera, Giorgianni Andrea, Marco Mauri, William Auteri, Alfredo Petrone, Carlo Cirelli, Anne Falcou, Simona Corraine, Valeria Piras, Giuseppe Ganci, Tiziana Tassinari, Nunzio Paolo Nuzzi, Manuel Corato, Simona Sacco, Guido Squassina, Paolo Invernizzi, Ivan Gallesio, Delfina Ferrandi, Giovanni Dui, Gianluca Deiana, Pietro Amistà, Monia Russo, Francesco Pintus, Antonio Baule, Giuseppe Craparo, Marina Mannino, Lucio Castellan, Danilo Toni, Salvatore Mangiafico International Journal of Stroke, 2021 Background There are limited data concerning procedure-related complications of endovascular thrombectomy for large vessel occlusion strokes. Aims We evaluated the cumulative incidence, the clinical relevance in terms of increased disability and mortality, and risk factors for complications. Methods From January 2011 to December 2017, 4799 patients were enrolled by 36 centers in the Italian Registry of Endovascular Stroke Treatment. Data on demographic and procedural characteristics, complications, and clinical outcome at three months were prospectively collected. Results The complications cumulative incidence was 201 per 1000 patients undergoing endovascular thrombectomy. Ongoing antiplatelet therapy (p < 0.01; OR 1.82, 95% CI: 1.21–2.73) and large vessel occlusion site (carotid-T, p < 0.03; OR 3.05, 95% CI: 1.13–8.19; M2-segment-MCA, p < 0.01; OR 4.54, 95% CI: 1.66–12.44) were associated with a higher risk of subarachnoid hemorrhage/arterial perforation. Thrombectomy alone (p < 0.01; OR 0.50, 95% CI: 0.31–0.83) and younger age (p < 0.04; OR 0.98, 95% CI: 0.97–0.99) revealed a lower risk of developing dissection. M2-segment-MCA occlusion (p < 0.01; OR 0.35, 95% CI: 0.19–0.64) and hypertension (p < 0.04; OR 0.77, 95% CI: 0.6–0.98) were less related to clot embolization. Higher NIHSS at onset (p < 0.01; OR 1.04, 95% CI: 1.02–1.06), longer groin-to-reperfusion time (p < 0.01; OR 1.05, 95% CI: 1.02–1.07), diabetes (p < 0.01; OR 1.67, 95% CI: 1.25–2.23), and LVO site (carotid-T, p < 0.01; OR 1.96, 95% CI: 1.26–3.05; M2-segment-MCA, p < 0.02; OR 1.62, 95% CI: 1.08–2.42) were associated with a higher risk of developing symptomatic intracerebral hemorrhage compared to no/asymptomatic intracerebral hemorrhage. The subgroup of patients treated with thrombectomy alone presented a lower risk of symptomatic intracerebral hemorrhage (p < 0.01; OR 0.70; 95% CI: 0.55–0.90). Subarachnoid hemorrhage/arterial perforation and symptomatic intracerebral hemorrhage after endovascular thrombectomy worsen both functional independence and mortality at three-month follow-up (p < 0.01). Distal embolization is associated with neurological deterioration (p < 0.01), while arterial dissection did not affect clinical outcome at follow-up. Conclusions Complications globally considered are not uncommon and may result in poor clinical outcome. Early recognition of risk factors might help to prevent complications and manage them appropriately in order to maximize endovascular thrombectomy benefits.
Vascular pattern and radiological follow up in a case of pontine warning syndrome Carmelo Tiberio Currò, Isabella Francalanza, Masina Cotroneo, Cristina Dell’Aera, Carmela Casella, Paolino La Spina, Maria Carolina Fazio, Francesco Grillo, Antonio Toscano, Rosa Fortunata Musolino Heliyon, 2021 Pontine warning syndrome (PWS) is a condition characterized by crescendo transient ischemic attacks due to pontine ischemia. The reported case described a 72-year-old woman who presented repetitive sudden episodes of double vision, impaired balance, slurred speech and right-sided weakness. Neurological deficits lasted a few minutes-hours and disappeared during the first seven days after onset. On the 1st day, MRI revealed acute left paramedian pontine infarction with focal swelling. Supra-aortic vessel imagining revealed bilateral internal carotid stenosis of 50%; hypoplasia of the left vertebral artery. On the 7th day, MRI showed a tissue swelling reduction, and from that day, she had no symptoms. These clinical and radiological features were suggestive of PWS. Our patient presented a particular vascular pattern that could favour symptoms fluctuation. We performed a close MRI follow up and it allowed us to observe a clinical stabilization in association with edema reduction.
Mechanical Thrombectomy for Acute Intracranial Carotid Occlusion with Patent Intracranial Arteries: The Italian Registry of Endovascular Treatment in Acute Stroke Fabrizio Sallustio, , Valentina Saia, Federico Marrama, Giovanni Pracucci, Roberto Gandini, Giacomo Koch, Alfredo Paolo Mascolo, Federica D’Agostino, Alessandro Rocco, Renato Argiro’, Marco Nezzo, Daniele Morosetti, Andrea Wlderk, Valerio Da Ros, Marina Diomedi, Leonardo Renieri, Patrizia Nencini, Stefano Vallone, Andrea Zini, Guido Bigliardi, Antonio Caragliano, Isabella Francalanza, Sandra Bracco, Rossana Tassi, Mauro Bergui, Andrea Naldi, Andrea Saletti, Alessandro De Vito, Roberto Gasparotti, Mauro Magoni, Luigi Cirillo, Christian Commodaro, Sara Biguzzi, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Ilaria Grisendi, Mirco Cosottini, Giovanni Orlandi, Alessio Comai, Enrica Franchini, Francesco D’Argento, Giovanni Frisullo, Edoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Andrea Boghi, Gigliola Chianale, Raffaele Augelli, Manuel Cappellari, Luigi Chiumarulo, Marco Petruzzellis, Alessandro Sgreccia, Piera Tosi, Nicola Cavasin, Adriana Critelli, Vittorio Semeraro, Giovanni Boero, Francesco Vizzari, Lucia Princiotta Cariddi, Olindo Di Benedetto, Pierfrancesco Pugliese, Marta Iacobucci, Manuela De Michele, Federico Fusaro, Jessica Moller, Luca Allegretti, Tiziana Tassinari, Nunzio Paolo Nuzzi, Simona Marcheselli, Simona Sacco, Marco Pavia, Paolo Invernizzi, Ivan Gallesio, Luigi Ruiz, Sandro Zedda, Rosario Rossi, Pietro Amistà, Monia Russo, Francesco Pintus, Alessandra Sanna, Giuseppe Craparo, Marina Mannino, Domenico Inzitari, Salvatore Mangiafico, Danilo Toni Clinical Neuroradiology, 2021 Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion. A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated. Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome. Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.
Endovascular Thrombectomy for Acute Ischemic Stroke beyond 6 Hours from Onset: A Real-World Experience Ilaria Casetta, Enrico Fainardi, Valentina Saia, Giovanni Pracucci, Marina Padroni, Leonardo Renieri, Patrizia Nencini, Domenico Inzitari, Daniele Morosetti, Fabrizio Sallustio, Stefano Vallone, Guido Bigliardi, Andrea Zini, Marcello Longo, Isabella Francalanza, Sandra Bracco, Ignazio M. Vallone, Rossana Tassi, Mauro Bergui, Andrea Naldi, Andrea Saletti, Alessandro De Vito, Roberto Gasparotti, Mauro Magoni, Lucio Castellan, Carlo Serrati, Roberto Menozzi, Umberto Scoditti, Francesco Causin, Alessio Pieroni, Edoardo Puglielli, Alfonsina Casalena, Antioco Sanna, Maria Ruggiero, Francesco Cordici, Luca Di Maggio, Enrica Duc, Mirco Cosottini, Nicola Giannini, Giuseppina Sanfilippo, Federico Zappoli, Anna Cavallini, Nicola Cavasin, Adriana Critelli, Elisa Ciceri, Mauro Plebani, Manuel Cappellari, Luigi Chiumarulo, Marco Petruzzellis, Alberto Terrana, Lucia Princiotta Cariddi, Nicola Burdi, Angelica Tinelli, William Auteri, Umberto Silvagni, Francesco Biraschi, Ettore Nicolini, Riccardo Padolecchia, Tiziana Tassinari, Pietro Filauri, Simona Sacco, Marco Pavia, Paolo Invernizzi, Nunzio P. Nuzzi, Simona Marcheselli, Pietro Amistà, Monia Russo, Ivan Gallesio, Giuseppe Craparo, Marina Mannino, Salvatore Mangiafico, Danilo Toni, and Stroke, 2020 Background and Purpose: To evaluate outcome and safety of endovascular treatment beyond 6 hours of onset of ischemic stroke due to large vessel occlusion in the anterior circulation, in routine clinical practice. Methods: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke of known onset beyond 6 hours. Additional inclusion criteria were prestroke modified Rankin Scale score ≤2 and ASPECTS score ≥6. Patients were selected on individual basis by a combination of CT perfusion mismatch (difference between total hypoperfusion and infarct core sizes) and CT collateral score. The primary outcome measure was the score on modified Rankin Scale at 90 days. Safety outcomes were 90-day mortality and the occurrence of symptomatic intracranial hemorrhage. Data were compared with those from patients treated within 6 hours. Results: Out of 3057 patients, 327 were treated beyond 6 hours. Their mean age was 66.8±14.9 years, the median baseline National Institutes of Health Stroke Scale 16, and the median onset to groin puncture time 430 minutes. The most frequent site of occlusion was middle cerebral artery (45.1%). Functional independence (90-day modified Rankin Scale score, 0–2) was achieved by 41.3% of cases. Symptomatic intracranial hemorrhage occurred in 6.7% of patients, and 3-month case fatality rate was 17.1%. The probability of surviving with modified Rankin Scale score, 0–2 (odds ratio, 0.58 [95% CI, 0.43–0.77]) was significantly lower in patients treated beyond 6 hours as compared with patients treated earlier No differences were found regarding recanalization rates and safety outcomes between patients treated within and beyond 6 hours. There were no differences in outcome between people treated 6-12 hours from onset (278 patients) and those treated 12 to 24 hours from onset (49 patients). Conclusions: This real-world study suggests that in patients with large vessel occlusion selected on the basis of CT perfusion and collateral circulation assessment, endovascular treatment beyond 6 hours is feasible and safe with no increase in symptomatic intracranial hemorrhage.
Recurrent intracranial hemorrhage and cerebral venous sinus thrombosis: an atypical case of Neuro-Behçet's Syndrome Fabrizio Giammello, Cristina Dell’Aera, Francesco Grillo, Masina Cotroneo, Carmela Casella, Maria Carolina Fazio, Paolino La Spina, Isabella Francalanza, Alessia Fiorenza, Antonio Toscano, Fabiola Atzeni, Rosa Fortunata Musolino Clinical Neurology and Neurosurgery, 2020 We report the case of a 22-year-old man with an history of headaches, seizures, cognitive impairment associated with recurrent intracranial hemorrhage (ICH), acute ischemic stroke (AIS), worsened over the last eighteen months for a new onset of uveitis and cerebral venous sinus thrombosis (CVST). After excluding common causes of lobar ICH, and some rare ones according to the diagnostic protocol proposed by Beuker et al, in the suspicion of Primary Angiitis of the Central Nervous System (PACNS), the gradual development of a low-grade fever, a cutaneous rash, and a papulopustular manifestation on lower back after rachicentesis (pathergy phenomenon), allowed us to make a diagnosis of Neuro-Behçet's Syndrome (NBS) without oral/genital aphthous ulcerations, according to the International Study Group for Behçet's Disease classification criteria for BD (ICBD).
Acute Stroke Treatment in Patients with Basilar Artery Occlusion: A Single-Center Observational Study Isabella Francalanza, Antonio Ciacciarelli, Antonio Armando Caragliano, Carmela Casella, Masina Cotroneo, Cristina Dell’Aera, Maria Carolina Fazio, Francesco Grillo, Antonio Pitrone, Sergio Lucio Vinci, Giuseppe Trimarchi, Rosa Fortunata Musolino, Paolino La Spina Cerebrovascular Diseases Extra, 2019 Background: Acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) represents 1–4% of all ischemic strokes. BAO results in strokes associated with a high risk of a poor functional outcome and, in 86–95% of the untreated cases, it results in death because of the vital cerebral structures involved. Diagnosis can be delayed because of the variability in presenting symptoms, and acute treatment is often attempted even beyond 6 h from symptoms onset because of the high risk of a fatal prognosis. Objective: In this observational study, we retrospectively analyzed patients with AIS due to BAO referred to the stroke center of the University Hospital of Messina. We aimed to assess prognostic factors and to evaluate the association between clinical outcome and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) and collateral status. Method: BAO was confirmed by cerebral computed tomography (CT) angiography or cerebral angiography. All patients underwent CT scan and magnetic resonance imaging (MRI). We assessed the pc-ASPECTS on diffusion-weighted imaging (DWI) MR images and the Posterior Circulation Collateral Score (PC-CS) for every patient. Functional outcome was assessed at 3 months using the modified Rankin Scale (mRS). Results: The study population consisted of 27 patients; 16 males and 11 females. The mean age was 66 (±14) years. We observed a favorable outcome (mRS 0–3) in 40.7% of cases, 25.9% reached mRS 0–2, and 29.6% had a poor clinical outcome (mRS 4–5). Patient survival was 70.4%, whereas 8 patients died (29.6%). In 7 patients, pc-ASPECTS was ≥7. According to the PC-CS, 33.3% had moderate collaterals and 63.0% had good collateral status prior to receiving the treatment. Favorable outcome was significantly associated with age, NIHSS score at admission, pc-ASPECTS, hypercholesterolemia, and female sex but not with the other risk factors. Conclusions: In our study, we found that younger age, low NIHSS score at admission, and high pc-ASPECTS, but not onset to treatment time, are associated with a favorable clinical outcome. Transferred patients did not have a significantly poorer outcome. These findings confirm that acute stroke treatment improves clinical outcome in BAO patients, in spite of a delayed diagnosis and an extended therapeutic window, considering lesion volume and localization in DWI MRI.
