Publications by authors named "Salvatore Mangiafico"
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).
Article Synopsis
- The study aimed to explore treatment strategies for tandem occlusions (TOs) during emergent carotid stenting in Italy, highlighting uncertainties in the best approach despite benefits from mechanical thrombectomy.
- A survey of 66 centers yielded a response rate of 84.8%, revealing that most prefer a retrograde approach with a closed-cell stent and single antiplatelet therapy during deployment.
- The findings indicate that practices for managing TOs are inconsistent across the Italian neurovascular community, emphasizing the need for more evidence to establish a standardized treatment protocol.
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 PDFAssociation between procedural time and outcome in unsuccessful mechanical thrombectomy for acute ischemic stroke: analysis from the Italian Registry of Endovascular Treatment in Acute Stroke.
J Neurol
August 2024
Background: 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.
Background And Objectives: This multicenter study aimed to assess the safety and efficacy of the Woven EndoBridge (WEB) device for treating unruptured wide-neck intracranial bifurcation aneurysms (WIBAs) with short-, mid-, and long-term follow-ups (FUPs).
Methods: Consecutive patients with unruptured WIBAs treated with WEB between December 2014 and January 2018 were included. Patient, aneurysm, and device characteristics were collected and analyzed retrospectively.
Tau protein is implicated in the pathogenesis of Alzheimer's disease (AD) and other tauopathies, but its physiological function is in debate. Mostly explored in the brain, tau is also expressed in the pancreas. We further explored the mechanism of tau's involvement in the regulation of glucose-stimulated insulin secretion (GSIS) in islet β-cells, and established a potential relationship between type 2 diabetes mellitus (T2DM) and AD.
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.
IV thrombolysis plus thrombectomy versus IV thrombolysis alone for minor stroke with anterior circulation large vessel occlusion from the IRETAS and Italian SITS-ISTR cohorts.
Neurol Sci
December 2023
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.
Background: 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.
Despite the increasing popularity of flow diverters (FDs) as an endovascular option for intracranial aneurysms, the treatment of complex aneurysms still represents a challenge. Combined strategies using a flow-preservation bypass could be considered in selected cases. In this study, we retrospectively reviewed our series of patients with complex intracranial aneurysms submitted to bypass.
View Article and Find Full Text PDFCarotid artery stenting during endovascular thrombectomy for acute ischemic stroke with tandem occlusion: the Italian Registry of Endovascular Treatment in Acute Stroke.
Acta Neurol Belg
April 2023
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.
Favourable collaterals according to the Careggi Collateral Score grading system in patients treated with thrombectomy for stroke with middle cerebral artery occlusion.
J Thromb Thrombolysis
October 2022
The ability of the current grading systems to predict optimal outcomes in stroke patients with favourable collaterals remains unexplored. We evaluated differences in the performance of grading systems between Careggi Collateral Score and ASITN/SIR collateral score to predict clinical and radiological outcomes in stroke patients with favourable collaterals who underwent thrombectomy. We included stroke patients receiving thrombectomy within 360 min after symptom onset with MCA occlusion and favourable collaterals (i.
View Article and Find Full Text PDFBackground 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.
In 2014, Chapot et al. introduced the pressure cooker technique (PCT), conceived to control undesired reflux of the embolic agent during the treatment of brain arterio-venous malformations (bAVMs). Since then, this technique increased in popularity and it has been extensively used.
View Article and Find Full Text PDFArticle 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.
Article Synopsis
- The study aimed to assess how effective time to maximum concentration (T)-based target mismatch on computed tomography perfusion (CTP) is in predicting outcomes for patients with acute ischemic stroke (AIS) who undergo endovascular treatment (EVT).
- Researchers analyzed 393 AIS patients and found that certain T thresholds (specifically T > 16 seconds) were strong predictors of final infarct volume (FIV) and clinical outcomes after treatment.
- Results indicated that a T > 16 seconds volume of 67ml or less enhanced the likelihood of achieving a favorable outcome, with high sensitivity and specificity metrics, highlighting its potential utility in clinical decision-making.
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.
Correction to: Association of the Careggi Collateral Score with 3-month modified Rankin Scale score after thrombectomy for stroke with occlusion of the middle cerebral artery.
J Neurol
February 2022