1.Characteristics of Early Presenters after Intracerebral Hemorrhage
Andrea MOROTTI ; Jawed NAWABI ; Frieder SCHLUNK ; Loris POLI ; Paolo COSTA ; Federico MAZZACANE ; Giorgio BUSTO ; Elisa SCOLA ; Francesco ARBA ; Laura BRANCALEONI ; Sebastiano GIACOMOZZI ; Luigi SIMONETTI ; Michele LAUDISI ; Anna CAVALLINI ; Massimo GAMBA ; Mauro MAGONI ; Roberto GASPAROTTI ; Alessandro PADOVANI ; Alessandro PEZZINI ; Andrea ZINI ; Enrico FAINARDI ; Ilaria CASETTA
Journal of Stroke 2022;24(3):425-428
2.History of Migraine and Volume of Brain Infarcts: The Italian Project on Stroke at Young Age (IPSYS)
Valeria De GIULI ; Michele BESANA ; Mario GRASSI ; Marialuisa ZEDDE ; Andrea ZINI ; Corrado LODIGIANI ; Simona MARCHESELLI ; Anna CAVALLINI ; Giuseppe MICIELI ; Maurizia RASURA ; Maria Luisa DELODOVICI ; Giampaolo TOMELLERI ; Nicoletta CHECCARELLI ; Alberto CHITI ; Elisa GIORLI ; Massimo Del SETTE ; Lucia TANCREDI ; Antonella TORIELLO ; Massimiliano BRAGA ; Andrea MOROTTI ; Loris POLI ; Filomena CARIA ; Massimo GAMBA ; Rosalba PATELLA ; Alessandra SPALLONI ; Anna Maria SIMONE ; Rosario PASCARELLA ; Sandro BERETTA ; Enrico FAINARDI ; Alessandro PADOVANI ; Roberto GASPAROTTI ; Alessandro PEZZINI ;
Journal of Stroke 2019;21(3):324-331
BACKGROUND AND PURPOSE: Migraine has been shown to increase cerebral excitability, promote rapid infarct expansion into tissue with perfusion deficits, and result in larger infarcts in animal models of focal cerebral ischemia. Whether these effects occur in humans has never been properly investigated. METHODS: In a series of consecutive patients with acute ischemic stroke, enrolled in the setting of the Italian Project on Stroke at Young Age, we assessed acute as well as chronic infarct volumes by volumetric magnetic resonance imaging, and compared these among different subgroups identified by migraine status. RESULTS: A cohort of 591 patients (male, 53.8%; mean age, 37.5±6.4 years) qualified for the analysis. Migraineurs had larger acute infarcts than non-migraineurs (median, 5.9 cm³ [interquartile range (IQR), 1.4 to 15.5] vs. 2.6 cm³ [IQR, 0.8 to 10.1], P<0.001), and the largest volumes were observed in patients with migraine with aura (median, 9.0 cm³ [IQR, 3.4 to 16.6]). In a linear regression model, migraine was an independent predictor of increased log (acute infarct volumes) (median ratio [MR], 1.64; 95% confidence interval [CI], 1.22 to 2.20), an effect that was more prominent for migraine with aura (MR, 2.92; 95% CI, 1.88 to 4.54). CONCLUSIONS: These findings reinforce the experimental observation of larger acute cerebral infarcts in migraineurs, extend animal data to human disease, and support the hypothesis of increased vulnerability to ischemic brain injury in people suffering migraine.
Animals
;
Brain Injuries
;
Brain Ischemia
;
Brain
;
Cohort Studies
;
Cortical Spreading Depression
;
Humans
;
Linear Models
;
Magnetic Resonance Imaging
;
Migraine Disorders
;
Migraine with Aura
;
Models, Animal
;
Perfusion
;
Risk Factors
;
Stroke
3.Recanalization Therapies for Large Vessel Occlusion Due to Cervical Artery Dissection: A Cohort Study of the EVA-TRISP Collaboration
Christopher TRAENKA ; Johannes LORSCHEIDER ; Christian HAMETNER ; Philipp BAUMGARTNER ; Jan GRALLA ; Mauro MAGONI ; Nicolas MARTINEZ-MAJANDER ; Barbara CASOLLA ; Katharina FEIL ; Rosario PASCARELLA ; Panagiotis PAPANAGIOTOU ; Annika NORDANSTIG ; Visnja PADJEN ; Carlo W. CEREDA ; Marios PSYCHOGIOS ; Christian H. NOLTE ; Andrea ZINI ; Patrik MICHEL ; Yannick BÉJOT ; Andreas KASTRUP ; Marialuisa ZEDDE ; Georg KÄGI ; Lars KELLERT ; Hilde HENON ; Sami CURTZE ; Alessandro PEZZINI ; Marcel ARNOLD ; Susanne WEGENER ; Peter RINGLEB ; Turgut TATLISUMAK ; Paul J. NEDERKOORN ; Stefan T. ENGELTER ; Henrik GENSICKE ;
Journal of Stroke 2023;25(2):272-281
Background:
and Purpose This study aimed to investigate the effect of endovascular treatment (EVT, with or without intravenous thrombolysis [IVT]) versus IVT alone on outcomes in patients with acute ischemic stroke (AIS) and intracranial large vessel occlusion (LVO) attributable to cervical artery dissection (CeAD).
Methods:
This multinational cohort study was conducted based on prospectively collected data from the EVA-TRISP (EndoVAscular treatment and ThRombolysis for Ischemic Stroke Patients) collaboration. Consecutive patients (2015–2019) with AIS-LVO attributable to CeAD treated with EVT and/or IVT were included. Primary outcome measures were (1) favorable 3-month outcome (modified Rankin Scale score 0–2) and (2) complete recanalization (thrombolysis in cerebral infarction scale 2b/3). Odds ratios with 95% confidence intervals (OR [95% CI]) from logistic regression models were calculated (unadjusted, adjusted). Secondary analyses were performed in the patients with LVO in the anterior circulation (LVOant) including propensity score matching.
Results:
Among 290 patients, 222 (76.6%) had EVT and 68 (23.4%) IVT alone. EVT-treated patients had more severe strokes (National Institutes of Health Stroke Scale score, median [interquartile range]: 14 [10–19] vs. 4 [2–7], P<0.001). The frequency of favorable 3-month outcome did not differ significantly between both groups (EVT: 64.0% vs. IVT: 86.8%; ORadjusted 0.56 [0.24–1.32]). EVT was associated with higher rates of recanalization (80.5% vs. 40.7%; ORadjusted 8.85 [4.28–18.29]) compared to IVT. All secondary analyses showed higher recanalization rates in the EVT-group, which however never translated into better functional outcome rates compared to the IVT-group.
Conclusion
We observed no signal of superiority of EVT over IVT regarding functional outcome in CeAD-patients with AIS and LVO despite higher rates of complete recanalization with EVT. Whether pathophysiological CeAD-characteristics or their younger age might explain this observation deserves further research.