Publications by authors named "Enrico M Lotti"
Background: Data on cardioembolic prevention with direct oral anticoagulants (DOAC) in atrial fibrillation (AF) patients with previous gastric surgery are lacking. We report inter- and intra-individual differences in DOAC concentration in people with gastric surgery, to identify potential treatment options.
Methods: Patients with previous gastric surgery receiving DOAC for AF as stroke secondary prevention, and undergoing peak-trough DOAC plasmatic testing were selected from the regional EDDIE-AF registry.
Article Synopsis
- Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are effective treatments for acute stroke, but their safety and efficacy in patients with atrial fibrillation (AF) are debated.
- A study analyzed data from two multicenter studies to compare outcomes of AF patients with acute ischemic stroke treated with reperfusion therapies versus those who weren't.
- Results showed that AF patients treated with reperfusion therapies had better functional outcomes and lower mortality rates compared to those who received conservative treatment.
Article Synopsis
- The study investigates the best treatment approach for patients with mechanical heart valves experiencing acute ischemic strokes while on vitamin K antagonists, comparing bridging therapy with full dose heparin to nonbridging therapy without heparin.
- Data was collected from multiple centers via retrospective registries, with a focus on outcomes such as stroke, bleeding, and embolism after 90 days using propensity score matching to ensure accurate comparisons.
- Results indicated that while bridging therapy was associated with a higher incidence of adverse events, both strategies presented risks, with bridging patients showing a marginally increased risk for ischemic and bleeding complications compared to the nonbridging group.
Objective: Epidemiological data to characterize the individual risk profile of patients with spontaneous cervical artery dissection (sCeAD) are rather inconsistent.
Methods And Results: In the setting of the Italian Project on Stroke in Young Adults Cervical Artery Dissection (IPSYS CeAD), we compared the characteristics of 1,468 patients with sCeAD (mean age = 47.3 ± 11.
Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study.
Stroke
August 2022
Article Synopsis
- A study was conducted on patients with atrial fibrillation who had an ischemic stroke while using nonvitamin K antagonist oral anticoagulants to determine rates and risk factors for recurrent ischemic and bleeding events.
- Over an average follow-up of about 15 months, 15.5% of the 1,240 patients experienced 207 events, including ischemic strokes and major bleeding incidents, with specific risk factors identified for each type of event.
- The rates of ischemic and bleeding events did not significantly differ between patients who changed their anticoagulant treatment and those who continued with it.
Objective: To explore the impact of antithrombotic therapy discontinuation in the postacute phase of cervical artery dissection (CeAD) on the mid-term outcome of these patients.
Methods: In a cohort of consecutive patients with first-ever CeAD, enrolled in the setting of the multicentre Italian Project on Stroke in Young Adults Cervical Artery Dissection, we compared postacute (beyond 6 months since the index CeAD) outcomes between patients who discontinued antithrombotic therapy and patients who continued taking antithrombotic agents during follow-up. Primary outcome was a composite of ischaemic stroke and transient ischaemic attack.
Article Synopsis
- The study analyzed the relationship between the Careggi Collateral Score (CCS) and radiological outcomes in 1,785 patients who underwent thrombectomy for middle cerebral artery (MCA) occlusions, revealing significant findings.* -
- CCS scores range from 0 (no retrograde filling) to 4 (extensive collateral flow), with higher scores indicating better radiological outcomes related to infarct growth, cerebral bleeding, and edema at 24 hours post-treatment.* -
- Ordinal regression analysis showed that lower CCS scores (0-4) were associated with worse outcomes, suggesting that CCS may serve as a useful predictor in assessing the effectiveness of thrombectomy treatments in stroke patients.*
Article Synopsis
- The study aimed to evaluate the risks of recurrent ischemic events and severe bleeding in patients with acute posterior ischemic stroke (PS) and atrial fibrillation (AF) in relation to oral anticoagulant therapy (OAT) and timing of initiation.
- Researchers compared outcomes in 473 patients with PS to 1997 patients with anterior stroke (AS), focusing on events within 90 days of the initial stroke.
- Findings indicated that both PS and AS patients had similar risks of ischemic or hemorrhagic events at 90 days, regardless of when OAT was initiated.
Background And Purpose: Observational studies have suggested a link between fibromuscular dysplasia and spontaneous cervical artery dissection (sCeAD). However, whether patients with coexistence of the two conditions have distinctive clinical characteristics has not been extensively investigated.
Methods: In a cohort of consecutive patients with first-ever sCeAD, enrolled in the setting of the multicenter IPSYS CeAD study (Italian Project on Stroke in Young Adults Cervical Artery Dissection) between January 2000 and June 2019, we compared demographic and clinical characteristics, risk factor profile, vascular pathology, and midterm outcome of patients with coexistent cerebrovascular fibromuscular dysplasia (cFMD; cFMD+) with those of patients without cFMD (cFMD-).
Background: During the coronavirus disease 2019 (COVID-19) outbreak, a decrease of stroke's hospital admissions and reperfusion therapy has been reported worldwide. This retrospective observational study assessed the volume of stroke cases managed in the Emergency Department (ED) and reperfusion therapies in an Italian stroke network with a high incidence of COVID-19, particularly to evaluate if the in-hospital rerouting and the switch from a drip-and-ship to a mothership model could assure an adequate volume of acute treatments.
Methods: We compared data from March 2020 with those from previous years and formulated five PICO questions regarding (1) incidence of stroke cases in the ED; (2) relation between stroke cases and COVID-19; (3) differences in the number of reperfusion therapies, (4) in the call-to-needle and door-to-needle times for intravenous thrombolysis, and (5) in the call-to-groin and door-to-groin times for thrombectomy.
Introduction: Despite intravenous thrombolysis (IVT) and endovascular treatment (EVT) have been demonstrated effective in acute ischemic stroke (AIS) due to large vessel occlusions, there are still no conclusive data to guide treatment in stroke due to cervical internal carotid artery (ICA) occlusion. We systematically reviewed available literature to compare IVT, EVT, and bridging (IVT + EVT) and define optimal treatment.
Methods: Systematic review followed predefined protocol (Open-Science-Framework osf.
Long-term consequences of cervical artery dissection (CeAD), a major cause of ischemic stroke in young people, have been poorly investigated. The Italian Project on Stroke at Young Age - Cervical Artery Dissection (IPSYS CeAD) project is a multicenter, hospital-based, consecutively recruiting, observational, cohort study aimed to address clinically important questions about long-term outcome of CeAD patients, which are not covered by other large-scale registries. Patients with radiologically diagnosed CeAD were consecutively included in the registry.
View Article and Find Full Text PDFThe association between preceding treatment with antiplatelet agents (APs), vitamin K antagonists (VKAs) or direct oral anticoagulants (DOACs) and mortality after intracerebral hemorrhage (ICH) remains unclear. The aim of this multicenter, prospective cohort study was to assess the risk for death after ICH in consecutive patients who were on treatment with APs, VKAs, DOACs, or no antithrombotic agent. The primary outcome was in-hospital death by day 30.
View Article and Find Full Text PDFArticle Synopsis
- - This study investigates ischemic cerebrovascular events in patients with nonvalvular atrial fibrillation (AF) who are being treated with non-vitamin K antagonist oral anticoagulants (NOACs) to identify risk factors and understand the underlying mechanisms.
- - The research involved 713 patients who experienced ischemic strokes or transient ischemic attacks while on NOACs, and 700 who did not, revealing significant associations between these events and factors like low NOAC dosage, atrial enlargement, hyperlipidemia, and higher CHADS-VASc scores, which indicate greater stroke risk.
- - Findings suggest that while most strokes in this population were of cardioembolic origin, other factors such as being older,
Article Synopsis
- The study examined the link between types of atrial fibrillation (paroxysmal vs. sustained) and the occurrence of early ischaemic recurrences after an acute stroke in patients.
- Out of 2150 patients, those with sustained atrial fibrillation experienced a higher percentage of early ischaemic recurrences (6.2%) compared to those with paroxysmal atrial fibrillation (3.3%).
- However, after considering other health risks, sustained atrial fibrillation did not show a significantly increased risk for early recurrence, suggesting that other factors may be more influential.
Background In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation ( HT ). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT , (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset.
View Article and Find Full Text PDFObjective: Whether migraine modifies after spontaneous cervical artery dissection (sCeAD) more than after other stroke etiologic subtypes has never been adequately investigated.
Methods: In the setting of the Italian Project on Stroke in Young Adults (IPSYS), we compared the course of migraine before and after acute brain infarct in a group of migraine patients with sCeAD and a group of migraine patients whose ischemia was due to a cause other than CeAD (non-CeAD IS), matched by sex, age (± 3 years), and migraine subtype.We applied linear mixed models to evaluate pre-event vs post-event changes and differences between sCeAD and non-CeAD IS patients.
Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study.
J Am Heart Assoc
November 2017
Article Synopsis
- The study investigates the optimal timing for administering non-vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation, focusing on early recurrence of stroke and major bleeding within 90 days post-treatment.
- A total of 1,127 patients participated, with diverse treatment groups receiving dabigatran, rivaroxaban, or apixaban; results revealed a low incidence of early recurrence (2.8%) and major bleeding (2.4%).
- Patients starting NOACs within 2 days of stroke had higher rates of complications (12.4% composite rate), compared to delayed initiation (3-14 days had 2.1%, and >14 days
Importance: Although sparse observational studies have suggested a link between migraine and cervical artery dissection (CEAD), any association between the 2 disorders is still unconfirmed. This lack of a definitive conclusion might have implications in understanding the pathogenesis of both conditions and the complex relationship between migraine and ischemic stroke (IS).
Objective: To investigate whether a history of migraine and its subtypes is associated with the occurrence of CEAD.
Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients With Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study.
Stroke
March 2017
Background And Purposes: This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation.
Methods: The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.
Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease associated with a positive familial history in 5-10% of ALS cases. Mutations in the superoxide dismutase-1 (SOD1) gene have been found in 12%-23% of patients diagnosed with familial ALS. Here we report a novel mutation in exon 4 of SOD1 gene in a 55-year-old ALS patient belonging to a large Italian family with ALS first clinically described in 1968.
View Article and Find Full Text PDFObjective: The reciprocal relation between breathing, heart and motor system abnormalities during sleep was studied in multiple system atrophy (MSA) by means of video-polysomnographic recordings (VPSG).
Patients And Methods: Nineteen consecutive MSA patients underwent VPSG with scoring for sleep, respiratory abnormalities, heart (HR) and breathing (BR) rates, and abnormal motor activities. A comparative analysis was performed versus 10 patients with obstructive sleep apnoea syndrome (OSAS).