nicola limbucci - Profile on Academia.edu (original) (raw)

Papers by nicola limbucci

European stroke journal, Jun 2, 2022

Introduction:Although stroke occurs frequently in patients with cancer, there is scarce evidence ... more Introduction:Although stroke occurs frequently in patients with cancer, there is scarce evidence regarding the safety and efficacy of endovascular treatment (EVT) in patients with acute ischemic stroke and concurrent cancer. We performed a systematic review and meta-analysis to summarize the existing literature.Methods:We searched for English written observational studies reporting data on safety and efficacy of EVT in patients with acute ischemic stroke and concurrent cancer. Outcomes of interest were: functional independence (modified Rankin Scale (mRS) ⩽ 2); mortality at 3 months; rate of successful recanalization (modified Treatment In Cerebral Ischemia (mTICI) 2b or 3); occurrence of any hemorrhagic transformation (both symptomatic and asymptomatic). We pooled data with Maentel-Haenszel model to calculate cumulative odds ratios (ORs).Results:We included seven studies with a total of 4465 patients, of whom 262 (6%) with cancer. We observed various definitions of cancer across included studies. Patients with cancer had less likely mRS⩽2 at 3 months (24% vs 42%, OR = 0.44; 95% CI = 0.32–0.60) and increased probability of death (43% vs 19%, OR = 5.02; 95% CI = 2.90–8.69). There was no difference in successful recanalization (70% vs 75%, OR = 0.84; 95% CI = 0.49–1.44); patients with cancer had increased risk of any intracerebral hemorrhage after treatment (49% vs 34%, OR = 1.95; 95% CI = 1.28–2.96), though not for symptomatic ICH (OR 1.04; 95% CI = 0.59–1.85).Conclusion:Patients with acute ischemic stroke and cancer have similar EVT recanalization but higher probability of functional dependence, death, and any hemorrhagic transformation, though not necessarily symptomatic, compared with patients without cancer. Our results may help communication with patients and carers.

Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology frequently associat... more Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology frequently associated with dural sinus stenosis. There is emerging evidence that venous sinus stenting is an effective treatment. We use phase contrast cine MRI to observe changes in flow dynamics of multiple intracranial fluids and their response to different treatments in a patient with IIH. We quantified the following parameters at the level of the aqueduct of Sylvius and the cervical C2C3: cerebrospinal fluid (CSF), arterial and venous flow; CSF velocity amplitude; artero-venous delay (AVD); artero-CSF delay and percentage of venous outflow normalized to total arterial inflow (tIJV/tA). Analyses were run before lumbar puncture (LP) (A), after LP (B), after medical therapy (C) and after venous stent placements deployed at two separate times (D and E). AVD and tIJV/tA improved only after CSF removal and after stent placements. CSF velocity amplitude remained elevated. Arterial flow profile showed a dramatic reduction after LP with improvement in mean venous flow. This report is the first to demonstrate interactive changes in intracranial fluid dynamics that occur before and after different therapeutic interventions in IIH. We discuss how increased intracranial venous blood could be "tumoral" in IIH and facilitating its outflow could be therapeutic.

Valutare la funzionalità ventricolare sinistra di cuori con rimodellamento post-ischemico mediant... more Valutare la funzionalità ventricolare sinistra di cuori con rimodellamento post-ischemico mediante ecocardiografia e risonanza magnetica ed analizzarne le differenze. Materiali e metodi. Sono stati studiati 22 soggetti con rimodellamento ventricolare post-ischemico mediante ecocardiografia e risonanza magnetica cardiaca eseguita con sequenze cine-RM. I volumi ventricolari e la frazione d'eiezione sono stati calcolati in ecocardiografia col metodo di Simpson modificato e in risonanza magnetica mediante approccio tridimensionale non geometrico. I risultati sono stati confrontati con il t-test. Risultati. La frazione d'eiezione calcolata con ecocardiografia è stata costantemente più alta rispetto a quella ottenuta mediante risonanza magnetica. La frazione d'eiezione media ottenuta mediante ecocardiografia e risonanza magnetica sono state rispettivamente di 59.7 ± 4.5% e di 50.1 ± 2.5%. L'analisi statistica ha evidenziato una significativa discordanza dei valori ottenuti con le due metodiche (p<0.01). Conclusioni. Esiste una sostanziale sovrastima della frazione d'eiezione in soggetti con rimodellamento post-ischemico studiati con ecocardiografia. La risonanza magnetica, eseguita mediante cine-RM con metodica tridimensionale, risulta più accurata per l'assenza di dipendenza da assunti geometrici, che invece sono necessari per il calcolo dei volumi ventricolari con ecocardiografia. Purpose. To evaluate left ventricular function in hearts undergoing post-ischemic remodeling by means of echocardiography and magnetic resonance and to assess the differences. Materials and methods. Twenty-two patients post-ischemic left ventricular remodeling have been evaluated by echocardiography and cardiac magnetic resonance performed with cine-MRI sequences. Ventricular volumes and ejection fractions were calculated by applying the modified Simpson's rule to echocardiographic data and by means of 3D non-geometrical analysis of MRI data. Differences in the results of the two studies were evaluated with the t-test. Results. Ejection fractions based on echocardiographic data (mean: 59.7± 4.5%) were consistently higher than those obtained with MRI (mean: 50.1± 2.5%), and this discrepancy was statistically significant (p < 0.01). During myocardial remodeling, ejection fractions are significantly overestimated by echocardiography. This parameter can be more accurately calculated from data obtained with cine-MRI sequences and 3D technique. The latter approach is more accurate than echocardiography because it does not depend on the geometrical assumptions that underlie echocardiographic calculations of ventricular volume.

Alterazioni degenerative dello scheletro appendicolare

Springer eBooks, Jan 21, 2007

Journal of Neuroradiology, Sep 1, 2018

We report a case in which navigation of the micro catheter (Headway 027) with the conventional si... more We report a case in which navigation of the micro catheter (Headway 027) with the conventional single microwire technique became impossible because of the difficult intracranial vascular anatomy. In order to achieve access, we used two Terumo 012 inches micro guide-wires with a 45 • angle inside a single micro catheter. The manoeuver was easy and can be reproduced in specific and challenging cases.

Pathogenesis of syringomyelia

PubMed, 1993

Mucoid metaplastic-degeneration of anterior cruciate ligament

PubMed, Dec 1, 2008

Aim: Mucoid degeneration of the anterior cruciate ligament (ACL) is a pathological state not yet ... more Aim: Mucoid degeneration of the anterior cruciate ligament (ACL) is a pathological state not yet well morphologically defined, involving people without history of knee instability or significant trauma, and causing important pain. The aim of this study was to define the histopathological and radiographic features of this pathological condition. Methods: Analysis of 1 215 knee magnetic resonance (MR) examinations found 64 cases (5.3%) of ACL mucoid metaplastic-degeneration (MMD), subsequently all subjects underwent surgical and arthroscopic validation. MR examinations have been performed using a dedicate system provided with a permanent magnet of 0.18 T and with a dedicate coil of 12 cm of field of view (FOV) or an high field instrument with 1.5 T. Radiological criteria to define ACL MMD were based essentially on increased signal intensity in T2W sequences and in STIR ones, as in T1W scans the ligament showed an intermediate signal. Results: ACL MMD was diagnosed in 36 males and 28 females, with a mean age of 44 years. ''Segmentary MMD'' was found in 11 subjects (17.2%) commonly affecting the postero-lateral bundle of the ligament without femoral or tibial spongious mucoid intrusion. ''Total MMD'' (involving the entire ligament and accompanied with femoral or tibial intrusion) was found in 53 subjects (82.8%). Conclusion: The comparison between histopathological and MR findings suggests that the commonly called ACL mucoid degeneration (ACL MD) should be better defined as mucoid metaplastic degeneration (MMD).

Basic Neuro-Interventional Therapeutic Approaches

Springer eBooks, 2022

Congenital Malformations, Vascular, Brain

Springer eBooks, Jan 4, 2008

O-021 Pipeline embolization of posterior circulation aneurysms: a multicenter study of 131 aneurysms

Introduction Flow diversion for posterior circulation aneurysms using the Pipeline Embolization D... more Introduction Flow diversion for posterior circulation aneurysms using the Pipeline Embolization Device (PED) constitutes an increasingly common off-label use for otherwise untreatable aneurysms. Safety and efficacy of this treatment modality has not been assessed in a multicenter study. Methods A retrospective review of prospectively maintained databases at eight academic institutions was performed from the years 2009 to 2016 to identify patients with posterior circulation aneurysms treated with PED placement. Results One-hundred and twenty-nine consecutive patients underwent 129 procedures to treat 131 aneurysms. Twenty-nine dissecting, 53 fusiform, and 49 saccular were included. At a median follow-up of 11 months, complete and near complete occlusion was recorded in 78.1%. Dissecting aneurysms had the highest occlusion rate and fusiform the lowest. Major complications were most frequent in fusiform aneurysms. Minor complications occurred most commonly in saccular aneurysms. In patients with saccular aneurysms, clopidogrel responders had a lower complication rate than clopidogrel non-responders. The majority of dissecting aneurysms were treated in the acute phase following subarachnoid hemorrhage and were associated with the highest mortality rate; however, the rate of other major or minor complications was the lowest among the three aneurysm morphologies. The difference between complications in the ruptured and unruptured group was not statistically significant. Conclusion In the largest series to date, fusiform aneurysms were found to have the lowest occlusion rate and highest frequency of major complications. Dissecting aneurysms, frequently treated in the setting of subarachnoid hemorrhage, occluded most often and had the lowest complication rate. Saccular aneurysms were associated with predominantly minor complications, particularly in clopidogrel non-responders.

Il follow-up delle malattie aortiche

Springer eBooks, 2006

Mediante l’introduzione in ambito clinico della tomografia computerizzata multidetettore (TCMD) c... more Mediante l’introduzione in ambito clinico della tomografia computerizzata multidetettore (TCMD) con tecnica spirale si è ottenuto un notevole miglioramento dell’imaging vascolare. I vantaggi fondamentali della TCMD includono sostanzialmente tempi di acquisizione più rapidi, retrospettiva creazione di strati più sottili a partire dai dati grezzi dell’acquisizione e miglioramento delle ricostruzioni tridimensionali. Tali elementi nell’imaging del sistema vascolare si sintetizzano in tre

Headache and visual impairment after twin birth: a challenging diagnosis

Internal and Emergency Medicine, Jul 14, 2017

A 35-year-old woman presented to the Emergency Department (ED) 20 days after an uncomplicated twi... more A 35-year-old woman presented to the Emergency Department (ED) 20 days after an uncomplicated twin delivery by cesarean section. She complained of headache, visual field defect, left upper limb weakness, and fluctuating consciousness. The symptoms had started 6 days earlier, with severe fluctuating headache, scarcely responsive to analgesic medications, and visual disturbances. Subsequently, she noticed balance disorder and left upper limb numbness. Her clinical history was negative for smoking habits, hypertension, diabetes, migraine, hormone replacement, and substance abuse. She had undergone a catheter ablation for WPW syndrome 2 years prior. On arrival at the ED, the patient was in good general condition, conscious and oriented. Neurological examination showed a homonymous defect of the left visual field, mild weakness, and sensory impairment of the left upper limb. Blood pressure was 115/75 mmHg, heart rate 76 beats/min and transcutaneous oxygen saturation 98% in room air. Heart tones were normal and rhythmic, with no murmurs. Breath sounds were present without pathological noises. A head CT scan without contrast was normal. On the same day, the patient underwent a brain MRI protocol including conventional, gadolinium-enhanced, diffusion-weighted (DWI), and time-of-flight (TOF) angiographic (MRA) sequences. The analysis of fluid-attenuated inversion recovery (FLAIR) and turbo spin-echo (TSE) T2-weighted sequences showed two small foci of altered signal in the right parietal–occipital region and in the right external capsule with restricted diffusion at DWI, compatible with acute ischemic lesions. TOF MRA showed a widespread and irregular reduction of the arterial flow signal, mainly in the middle cerebral arteries and in the basilar district. There were no pathological signal enhancements after intravenous gadolinium. The echocardiogram and the Doppler ultrasound of carotid and vertebral arteries showed no abnormalities. The patient was treated with aspirin (325 mg) and admitted to our Stroke Unit. A few hours after arriving in the ward, the symptoms worsened with confusion and serious deterioration of the visual disturbances with the development of bilateral amaurosis. The patient quickly underwent another brain MRI/MRA that showed a large extension of the ischemic area in the right temporal–parietal–occipital region and a severe widespread decrease of the arterial flow signal (Fig. 1). At the end of the MRI, the patient spontaneously improved with almost full recovery of consciousness and partial recovery of the visual acuity. At that point, the patient was alert, oriented in space and time. She had a left homonymous visual field loss. She reported diminished pinprick, light touch, vibratory, position sense, and graphesthesia in the left upper and lower limb. Although sensory impairment in the left upper limb was marked, the & Alberto Fortini xfortini@alice.it

Rivista Di Neuroradiologia, Sep 1, 2009

Bilateral suprascapular nerve entrapment by glenoid labral cysts associated with rotator cuff damage and posterior instability in an amateur weightlifter

Journal of Sports Medicine and Physical Fitness, Mar 1, 2010

Suprascapular nerve entrapment is a common condition in athletes. The entrapment is most frequent... more Suprascapular nerve entrapment is a common condition in athletes. The entrapment is most frequently due to a "glenoid labral cyst" produced by joint fluid extrusion in consequence of labral degenerative changes. The bilaterality of the entrapment and the association with rotator cuff pathology are a rare evidence. We present the case of a 38-year-old amateur weightlifter with an history of left shoulder chronic posterior pain and progressive external rotation weakness, and with an acute right shoulder pain and weakness. Magnetic resonance imaging showed a bilateral glenoid labral cyst in association with partial tear of the supraspinatus tendon, atrophy of the infraspinatus muscle and type 2 SLAP lesion at the left shoulder and subacromial impingement syndrome (due to acromio-clavicular osteophyte), mild atrophy of the infraspinatus muscle and type 1-2 SLAP lesion at the right side.

World Neurosurgery, Oct 1, 2018

The safety and efficacy of flow diversion for distal circulation aneurysms of the cerebral vascul... more The safety and efficacy of flow diversion for distal circulation aneurysms of the cerebral vasculature has not been well evaluated. The objective of this study was to assess the use of flow diversion for distal circulation aneurysms (defined as at or beyond the M1, P1, and A1 segments of the middle cerebral artery, posterior cerebral artery, and anterior cerebral artery, respectively) in an international multicenter cohort.-CONCLUSIONS: Flow diversion for aneurysms beyond the circle of Willis has occlusion rates comparable to alternative treatments and low morbidity. The clinical significance of flow limitation through covered side branches requires further investigation.

Repeat Flow Diversion for Previously Failed Flow Diversion

Neurosurgery, Dec 1, 2020

Rheumatology, May 26, 2023

Objective. To report our single centre experience in treating 4 children affected by childhood pr... more Objective. To report our single centre experience in treating 4 children affected by childhood primary central nervous system vasculitis (cPACNS) using Mycophenolate Mofetil (MMF). Methods. From December 2011 to August 2015, 4 patients (3 males; age range: 9 months-13 years) affected by cPACNS were collected. Enrolled children received the following treatment protocol: acetylsalicylic acid and/or anticoagulant therapy with low molecular weight heparin (LMWH) 100 U/k BID replaced by acenocoumarol; methyl-prednisolone (30 mg/kg/day for 3-5 days) followed by prednisone (2 mg/kg/day), tapered and discontinued over 7-8 months; MMF used for induction therapy and subsequent maintenance phase (750-1000 mg/m 2 BID, half-dose for the first 10-15 days followed by full-dose). Results. In all children, no relapse of cerebral vasculitis occurred during the whole follow-up period and all of them improved while in MMF treatment. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), performed at 6, 9 or 12 months intervals, showed no progression or even improvement of the typical radiological findings. Medium period of MMF treatment was 29 months (range 10-42 months). No major drug-related adverse events were documented. We report for the first time on the efficacy and safety of MMF in the induction and maintenance of clinical remission in cPACNS. Our single centre experience of MMF use in treating cPACNS seems represent an appealing, alternative and safe option in this clinical setting over a long term follow-up.

Advances in Embolization of bAVMs

Acta neurochirurgica, 2016

Brain AVMs are complex malformations, usually congenital, that need a deep understanding of anato... more Brain AVMs are complex malformations, usually congenital, that need a deep understanding of anatomy and pathophysiology to be safely treated. Nowadays, embolization and radiosurgery are carried out more frequently due to their reduced invasiveness as compared to conventional neurosurgery. This paper aims to describe different and new endovascular approaches that allow the interventionalist to treat almost all the small AVMs and to reduce the nidus of the bigger ones in order to facilitate the surgical or radiosurgical intervention.

World Neurosurgery, May 1, 2017

Although secondary trigeminal neuralgia is usually due to tumours or multiple sclerosis, other ma... more Although secondary trigeminal neuralgia is usually due to tumours or multiple sclerosis, other major neurological diseases, such as aneurysms, should be taken into account when the history or the symptoms suggest a secondary origin. A 67-year-old lady presented with a 6-month history of trigeminal neuralgia involving exclusively the right ophthalmic division. A dedicated 3D-MRI-MRA study documented a very rare contact with a wide-necked aneurysm of the superior cerebellar artery, which distorted the trigeminal root. The patient underwent an endovascular treatment by stent assisted coiling with the complete disappearance of the neuralgic pain attacks within 24 hours. The complete relief from the neuralgic paroxysms immediately after endovascular stent assisted occlusion of a superior cerebellar artery aneurysm demonstrates the crucial role of a pulsating stimulus on the demyelinated nerve fibres in evoking the ectopicallygenerated discharges. Posterior circle aneurysms should be taken into account in the diagnosis of TN

Frontiers in Neurology, Jul 16, 2021

Background: The application of a new coating to the delivery wire of the Trevo retriever has the ... more Background: The application of a new coating to the delivery wire of the Trevo retriever has the potential to improve its handling. We therefore report our initial experience with this new stent retriever for mechanical thrombectomy of large and medium vessel occlusions. Methods: We pooled data of four high-volume European stroke centers over the time period from October 2020 to February 2021. Patients were included in our study if the Trevo NXT stent retriever was used as a first-line device. Primary endpoints were first-pass near-complete or complete reperfusion, defined as mTICI score of ≥2c. Secondary endpoints were final reperfusion, National Institutes of Health Stroke Scale (NIHSS) at 24 h and discharge, device malfunctions, complications during the procedure, and subjective ratings of the interventionalists regarding device functionality. Results: Eighty patients (39 women, mean age 74 ± 14 years) were eligible for our study. Median NIHSS at admission was 15 (IQR, 8-19), and median Alberta Stroke Program Early CT Score at baseline was 9 (IQR, 8-10). In 74 (93%) patients a primary combined approach was used as first-line technique. First-pass near-complete reperfusion was achieved in 43 (54%) and first-pass complete reperfusion in 34 (43%) patients. Final near-complete reperfusion was achieved in 66 (83%) patients after a median of 1.5 (1-3) passes, while final successful reperfusion was observed in 96% of our cases. We observed no device malfunctions. Median NIHSS at discharge was 2 (IQR, 0-5), and 3 patients (4%) suffered a symptomatic intracranial hemorrhage. Conclusions: Based on our initial data, we conclude that the Trevo NXT is an effective and safe tool for mechanical thrombectomy especially when used for combined approaches.