Publications by authors named "Pracucci G"
Background And Objectives: The benefit of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) with basilar artery occlusion (BAO) and a baseline National Institute of Health Stroke Scale (NIHSS) score <10 is unclear because this subpopulation has been substantially excluded from large clinical trials. The aim of our study was to determine whether MT ± IV thrombolysis (IVT) improves functional outcomes compared with IVT alone in patients with BAO and a NIHSS score <10.
Methods: We emulated a hypothetical trial including adult patients with BAO, a baseline NIHSS score <10, and prestroke modified Rankin scale (mRS) scores 0-2, comparing MT (±IVT) with IVT alone.
Introduction: Data on safety and efficacy of endovascular thrombectomy (EVT) for acute ischemic stroke in older patients are limited and controversial, and people aged 80 or older were under-represented in randomized trials. Our aim was to assess EVT effect for ischemic stroke patients aged ⩾80 at a nationwide level.
Patients And Methods: The cohort included stroke patients undergoing EVT from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).
Background: Mechanical thrombectomy (MT) was found to be beneficial in acute ischemic stroke patients with anterior tandem occlusion (a-TO). Instead, little is known about the effectiveness of MT in stroke patients with posterior tandem occlusion (p-TO). We aimed to compare MT within 24 h from last known well time in ischemic stroke patients with p-TO versus a-TO.
View Article and Find Full Text PDFBackground: We aim to assess the association between procedural time and outcomes in patients in unsuccessful mechanical thrombectomy (MT) for anterior circulation acute stroke.
Methods: We conducted a cohort study on prospectively collected data from patients with M1 and/or M2 segment of middle cerebral artery occlusion with a thrombolysis in cerebral infarction 0-1 at the end of procedure. Primary outcome was 90-day poor outcome.
Background: We investigated the impact of workflow times on the outcomes of patients treated with endovascular thrombectomy (EVT) in the late time window.
Methods: Individual patients' data who underwent EVT in the late time window (onset to imaging >6 hours) were pooled from seven registries and randomized clinical trials. Multiple time intervals were analyzed.
Article Synopsis
- Fabry disease (FD) is a rare genetic disorder linked to strokes, and there's ongoing debate about when to test for it in stroke patients.
- This study, part of the Fabry-Stroke Italian Registry, screened nearly 1,906 stroke patients for FD by checking alpha-galactosidase A activity and conducting genetic tests, identifying a small number of affected individuals.
- The findings suggest that limiting FD screening only to cryptogenic strokes could miss a significant number of cases, highlighting the importance of recognizing clinical signs that may indicate the need for testing.
Background: The right comprehension of ischemic stroke pathogenesis guarantees the best prevention therapy. The term "patent foramen ovale (PFO) related stroke" has been proposed for those events where PFO is supposed to be pathogenetic, but their definition is challenging. A multidisciplinary evaluation in a "Heart & Brain" team (HBteam) including stroke neurologists and interventional cardiologists was therefore highly recommended in the recent guidelines of secondary stroke prevention.
View Article and Find Full Text PDFBackground And Purpose: The weight of outcome predictors in acute ischemic stroke (AIS) patients older than 60 years is not necessarily mirrored in the younger population, posing the question of whether outcome determinants specific for the latter might vary. Very few data are available on predictors of outcome in young AIS patients receiving endovascular treatment (EVT).
Methods: We analyzed data for patients aged between 16 and 55 years from the Italian Registry of Endovascular Treatment in Acute Stroke.
Article Synopsis
- This study looked at how patients with a minor stroke are treated, comparing two methods: one using a drug called IVT and another method called MT, versus just IVT alone.
- They analyzed data from patients treated in Italy to see which method led to better health outcomes after a stroke.
- The results showed that while IVT plus MT had more complications in the short term, both treatment methods had similar long-term recovery outcomes.
Efficacy and safety of mechanical thrombectomy (MT) for stroke with posterior circulation large vessel occlusion (LVO) is still under debate. We aimed to compare the outcomes of stroke patients with posterior circulation LVO treated with intravenous thrombolysis (IVT) (< 4.5 h after symptom onset) plus MT < 6 h after symptom onset with those treated with IVT alone (< 4.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates predictors of hemorrhagic transformation (HT) and cerebral edema (CED) in stroke patients undergoing endovascular treatment after experiencing large vessel occlusion (LVO).
- It analyzes data from 1,400 patients to find clinical and procedural factors associated with these complications, identifying variables like diabetes, NIHSS scores, and ASPECTS ratings as significant predictors.
- Results show that HT occurred in 18% of patients and CED in 19.2%, with general anesthesia linked to a lower risk of HT, while factors like longer onset-to-groin times and invasive procedures raised the risk for both complications.
Background: Heart failure (HF) is the second most important cardiac risk factor for stroke after atrial fibrillation (AF). Few data are available on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with HF.
Methods: The source of data is the multicentre Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS).
Background And Purpose: The aim was to identify baseline clinical and radiological/procedural predictors and 24-h radiological predictors for clinical and functional outcomes in stroke patients obtaining complete recanalization in one pass of mechanical thrombectomy (MT) in an optimal baseline and procedural setting.
Methods: A retrospective analysis was conducted of prospectively collected data from 924 stroke patients with anterior large vessel occlusion, Alberta Stroke Program Early Computed Tomography (ASPECT) score ≥6 and pre-stroke modified Rankin Scale score 0, who started MT ≤6 h from symptom onset and obtained first-pass complete recanalization. A first logistic regression model was performed to identify baseline clinical predictors and a second model to identify baseline radiological/procedural predictors.
Outcomes with Endovascular Treatment of Patients with M2 Segment MCA Occlusion in the Late Time Window.
AJNR Am J Neuroradiol
April 2023
Background And Purpose: Randomized trials in the late window have demonstrated the efficacy and safety of endovascular thrombectomy in large-vessel occlusions. Patients with M2-segment MCA occlusions were excluded from these trials. We compared outcomes with endovascular thrombectomy in patients with M2-versus-M1 occlusions presenting 6-24 hours after symptom onset.
View Article and Find Full Text PDFBackground: The benefit, safety, and time intervals of mechanical thrombectomy (MT) in patients with in-hospital stroke (IHS) are unclear. We sought to evaluate the outcomes and treatment times for IHS patients compared with out-of-hospital stroke (OHS) patients receiving MT.
Methods: We analyzed data from the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) between 2015 and 2019.
Purpose: The anatomical proximity of the styloid process (SP) to the ipsilateral internal carotid artery (ICA) has been recently recognized as a possible risk factor for carotid artery dissection (CAD). We aimed to verify this hypothesis by comparing the minimum distance between SP and ICA in young adult patients (< 55 years) with and without CAD.
Methods: Thirty-one CAD patients (cases) were compared with 41 sex-matched patients without dissection, group one of control (G1), and with 16 sex-matched patients with vertebral artery dissection (VAD), group two of control (G2).
Background And Purpose: The multifactorial relationship between atrial fibrillation (AF) and cognitive impairment needs to be elucidated. The aim of this study was to assess, in AF patients on oral anticoagulants (OACs), the prevalence of cognitive impairment, defined according to clinical criteria or data-driven phenotypes, the prevalence of cognitive worsening, and factors associated with cognitive outcomes.
Methods: The observational prospective Strat-AF study enrolled AF patients aged ≥ 65 years who were receiving OACs.
Purpose: The management of tandem extracranial internal carotid artery and intracranial large vessel occlusion during endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) has been under-investigated. We sought to investigate outcomes of AIS patients with tandem occlusion (TO) treated with carotid artery stenting (CAS) compared to those not treated with CAS (no-CAS) during EVT.
Methods: We performed a cohort study using data from AIS patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke.
Background And Purpose: We sought to investigate whether there are gender differences in clinical outcome after stroke due to large vessel occlusion (LVO) after mechanical thrombectomy (EVT) in a large population of real-world patients.
Methods: From the Italian Registry of Endovascular Thrombectomy, we extracted clinical and outcome data of patients treated for stroke due to large vessel occlusion. We compared clinical and safety outcomes in men and women who underwent EVT alone or in combination with intravenous thrombolysis (IVT) in the total population and in a Propensity Score matched set.
Anticoagulants reduce embolic risk in atrial fibrillation (AF), despite increasing hemorrhagic risk. In this context, validity of congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke, vascular disease, age 65-74 years and sex category (CHADS-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS-BLED) scales, used to respectively evaluate thrombotic and hemorrhagic risks, is incomplete. In patients with AF, brain MRI has led to the increased detection of "asymptomatic" brain changes, particularly those related to small vessel disease, which also represent the pathologic substrate of intracranial hemorrhage, and silent brain infarcts, which are considered risk factors for ischemic stroke.
View Article and Find Full Text PDFBackground And Aim: Benefits of oral anticoagulants (OAC) in atrial fibrillation (AF) patients with moderate-to-high risk of stroke are independent of AF pattern. We evaluated whether AF clinical subtype influenced OAC use in a representative sample of the Italian older population.
Methods: A cross-sectional examination of all subjects aged 65 + years from three general practices in northern, central, and southern Italy started in 2016.
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 aims to identify factors predicting 3-month mRS scores and assess the impact of successful recanalization in stroke patients from the IRETAS cohort receiving endovascular treatment based on DIRECT-MT criteria.
- Using propensity score matching, researchers compared 137 patients receiving bridging therapy with 137 patients receiving only mechanical thrombectomy (MT) to analyze outcomes.
- Results showed differences in mRS scores and recanalization success rates between cohorts, with diabetes and certain predicators affecting outcomes; successful recanalization benefited patients with severe strokes and younger ages most significantly.
Background And Purpose: Collateral assessment using CT angiography is a promising modality for selecting patients for endovascular thrombectomy (EVT) in the late window (6-24 hours). The outcome of these patients compared with those selected using perfusion imaging is not clear.
Methods: We pooled data from seven trials and registries of EVT-treated patients in the late-time window.
Article Synopsis
- The study examined sex-related differences in outcomes for men and women who received endovascular treatment for acute stroke, specifically in late-presenting patients.
- Analysis was conducted using individual patient data from the SOLSTICE Consortium, comparing characteristics like age, functional independence after 90 days, mortality rates, and complications between the sexes.
- Results showed no significant differences in adjusted outcomes between men and women, although men had a higher likelihood of mortality and symptomatic intracranial hemorrhage, and women were generally older with fewer tandem occlusions.