Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke

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

Rotor fault detection of induction machines with optimal wavelet transform

Condition monitoring of electric machines is gaining interest in industry, because of increasing demand of fault tolerance machines. State-of-the-art diagnostic procedure are based on non-invasive signal processing of electrical signal that allow to detect fault signature at an incipient stage. Here, the use of Hilbert and Wavelet transform is investigated. Specifically, a theoretical analysis is presented that can be used to select the optimal wavelet, i.e. the decomposition level that corresponds to the maximum fault signature energy. Simulation results confirm the effectiveness of the proposed procedure, even under time-varying conditions

LA NOSTRA ESPERIENZA NELLA TERAPIA CHIRURGICA DELL'ERNIA IATALE: DALLA ALLISON ALLA NISSEN

5nonenoneMilone E.; Risaliti A.; Sasso F.; Cherubini M.; Forlivesi L.Milone, E.; Risaliti, Andrea; Sasso, F.; Cherubini, M.; Forlivesi, L

Correlation between cerebrospinal fluid markers of neurodegeneration and MRI measures of gray matter pathology in multiple sclerosis

Objective Pathological studies established that irreversible neurological disability in multiple sclerosis (MS) is associated with axonal and neuronal injury which can be detected by advanced cerebrospinal fluid (CSF) analysis and MRI techniques. However, the link between the two approaches and the advantage of combining them have not been explored in detail. This cross-sectional study is aimed at examining the correlation between CSF-detected neurodegeneration and MRI gray matter involvement in MS. Materials and Methods Starting from December 2011, consecutive patients with clinically isolated syndrome (CIS) or MS, diagnosed according to 2010 McDonald's criteria and with a CSF sample stored at Verona University Hospital Laboratory of Neuropathology have been considered eligible for the study. Enrolled subjects underwent CSF analysis, including ELISA to determine neurofilament light chain (NFL) concentration, and brain MRI, including volumetric T1-weighted, Fast Fluid Attenuated Inversion Recovery (FLAIR), and Double Inversion Recovery (DIR) sequences. All patients had a baseline neurological examination to estimate expanded disability status scale (EDSS) score. The correlation between CSF NFL concentration and MRI markers of gray matter pathology was analyzed as well as the association between these variables and neurological disability. Results As of May 2014, 40 eligible patients have been identified of which 25 have completed CSF analysis and MRI protocol. The study group is made of 17 females and 8 males with median age at inclusion of 31.5 (16.7-59.5) years. Three subjects have a CIS, 20 relapsing-remitting and 2 primary progressive MS with a median interval between clinical onset and study entry of 4.9 (0.1-379.5) months. Median EDSS score at CSF collection was 2.0 (0-4.0). Median CSF NFL concentration was 3304 (808-15000) ng/l and it did not change significantly according to sex, age, clinical course, disease duration and EDSS score. All patients had dissemination of lesions in space on MRI, while 8 subjects (32%) had one or more cortical lesions on DIR images. Median NFL concentration was 2854 (808-9973) ng/l in CSF of patients with evidence of cortical involvement and 3718 (1120-15000) ng/l in CSF of cases with no cortical lesions (p=0.6). Discussion and Conclusions In the present series, patients with MS and CIS had CSF NFL concentration well above the normal upper limit reported by previous studies. Based on preliminary results, NFL levels appear to be similar in the CSF of MS cases with and without cortical lesions detected on MRI. Further research on a larger sample and with additional measures is warranted

Physical disability and cognitive impairment evolution in benign multiple sclerosis: a five years prospective study

Background. Benign multiple sclerosis (BMS) definition is generally based on a minimum disease duration (DD) during which a maximum expanded disability status scale (EDSS) score is reached. However, EDSS does not account sufficiently for cognitive deficits, which may be as disabling as motor impairment Objectives. To study prospectively the evolution of physical disability and cognitive performance of BMS patients Methods. Among 300 patients seen at Verona MS Center between January and June 2008, 36 patients with relapsing-remitting (RR) course, DD 6510 years, and EDSS score 642.0 were defined BMS cases. Of these, 24 gave consent for inclusion in the study along with 13 sex- and age-matched non-benign MS (n-BMS) patients with RR course, DD 6510 years and EDSS score from 2.5 to 4.5. The two groups were followed for 5 years with neurological examination at least every year and neuropsychological assessment at baseline and at study conclusion. Conventional MRI analysis was done for patients who had a brain scan with the same protocol in 2008 and 2013. Results. At inclusion BMS subjects were 41\ub18 years old (mean\ub1standard deviation) with median DD of 15 years (range 11-29) and median EDSS score 1.5 (range 0-2), while n-BMS patients were 46\ub18 years old, had median DD of 16 years (range 10-27) and median EDSS score 3.0 (range 2.5-4.5). At baseline 16% of patients in both groups failed two or more neuropsychological tests. After 5 years, 23 BMS and 12 n-BMS patients had completed the study. The EDSS score worsened in 8% and 46% of cases, respectively (p=0.008), while the proportion of patients with 652 failed neuropsychological tests at 5 years increased at 25% in both groups. BMS and n-BMS patients who failed 652 tests had a significantly worse work and financial status both at baseline and at 5 years follow-up even after excluding subjects with EDSS score >3.5. Brain MRI T2 lesion location and number increase over time were not significantly associated with neurological and cognitive outcomes. Conclusions. Patients classified as having BMS according to widely used criteria had better physical disability outcome at 5 years compared to n-BMS cases. However, rates of initial cognitive impairment and neuropsychological decline over time did not differ between the two groups, including the possible impact on work and social functioning. Neuropsychological testing is essential even in MS patients with minimal or no physical disability given the distinct trajectories followed by disease progression in cognitive and motor domains