30 research outputs found
On Supply Reliability and Voltage Quality in the Presence of Feeder Automation in MV Smart Grids
No full textAnalysis of Supply Reliability and Voltage Quality (SR/VQ) in the presence of feeder automation in MV Smart Grids (SG) is addressed. After some recalls about methodological aspects, some feeder automation techniques adopted in Italy for fault detection and isolation are described. Then, models of the different automation procedures for a simple test system are developed. Numerical analyses aimed to evaluate SR/VQ indices for the different automation techniques are performed. Finally, a comparison among the effects in terms of expected number per user and per year of Long Interruptions (LI), Short Interruptions (SI) and Voltage Dips and of SARFI indexes is performed
Supply interruptions and voltage dips in smart distribution systems with feeder automation and reconfiguration
No full textThis paper analyses the impact of smart grid (SG) automation and reconfiguration functionalities on supply interruptions and voltage dips due to faults in medium voltage (MV) distribution systems. The analysis is illustrated using feeder automation and reconfiguration techniques adopted in Italy for fault detection and isolation, with reference to a simple MV homogeneous and symmetrical test network. The effects of temporary and permanent faults of different types and at different fault locations are evaluated in terms of changes of supply voltage, i.e. duration of long interruptions (LIs) and short interruption (SIs) and magnitude and duration of voltage dips (VDs), for different switching time sequences of the specific automation and reconfiguration techniques adopted. Afterwards, models of grid, automation systems, nodes and whole system are developed to allow for a more detailed and accurate evaluation of LIs, SIs and VDs, Finally, numerical analyses aimed to evaluate LI, SI and VD indices for the different automation techniques are performed and comparisons in terms of some reliability indices are reported
sj-doc-1-wso-10.1177_17474930231185690 – Supplemental material for Predictors for hemorrhagic transformation and cerebral edema in stroke patients with first-pass complete recanalization
No full textSupplemental material, sj-doc-1-wso-10.1177_17474930231185690 for Predictors for hemorrhagic transformation and cerebral edema in stroke patients with first-pass complete recanalization by Manuel Cappellari, Giovanni Pracucci, Valentina Saia, Fabrizio Sallustio, Ilaria Casetta, Enrico Fainardi, Francesco Capasso, Patrizia Nencini, Stefano Vallone, Guido Bigliardi, Andrea Saletti, Alessandro De Vito, Maria Ruggiero, Marco Longoni, Vittorio Semeraro, Giovanni Boero, Umberto Silvagni, Furio Stancati, Elvis Lafe, Federico Mazzacane, Sandra Bracco, Rossana Tassi, Simone Comelli, Maurizio Melis, Daniele Romano, Rosa Napoletano, Roberto Menozzi, Umberto Scoditti, Luigi Chiumarulo, Marco Petruzzellis, Sergio Lucio Vinci, Ludovica Ferraù, Francesco Taglialatela, Andrea Zini, Antioco Sanna, Tiziana Tassinari, Marta Iacobucci, Ettore Nicolini, Mauro Bergui, Paolo Cerrato, Andrea Giorgianni, Lucia Princiotta Cariddi, Pietro Amistà, Monia Russo, Ivan Gallesio, Federica Sepe, Alessio Comai, Enrica Franchini, Pietro Filauri, Berardino Orlandi, Michele Besana, Alessia Giossi, Guido Andrea Lazzarotti, Giovanni Orlandi, Davide Castellano, Andrea Naldi, Mauro Plebani, Cecilia Zivelonghi, Paolo Invernizzi, Salvatore Mangiafico and Danilo Toni in International Journal of Stroke</p
Supplemental material for IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke
No full textSupplemental Material for IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke by Manuel Cappellari, Salvatore Mangiafico, Valentina Saia, Giovanni Pracucci, Sergio Nappini, Patrizia Nencini, Daniel Konda, Fabrizio Sallustio, Stefano Vallone, Andrea Zini, Sandra Bracco, Rossana Tassi, Mauro Bergui, Paolo Cerrato, Antonio Pitrone, Francesco Grillo, Andrea Saletti, Alessandro De Vito, Roberto Gasparotti, Mauro Magoni, Edoardo Puglielli, Alfonsina Casalena, Francesco Causin, Claudio Baracchini, Lucio Castellan, Laura Malfatto, Roberto Menozzi, Umberto Scoditti, Chiara Comelli, Enrica Duc, Alessio Comai, Enrica Franchini, Mirco Cosottini, Michelangelo Mancuso, Simone Peschillo, Manuela De Michele, Andrea Giorgianni, Maria Luisa Delodovici, Elvis Lafe, Maria F Denaro, Nicola Burdi, Saverio Internò, Nicola Cavasin, Adriana Critelli, Luigi Chiumarulo, Marco Petruzzellis, Marco Doddi, Antonio Carolei, William Auteri, Alfredo Petrone, Riccardo Padolecchia, Tiziana Tassinari, Marco Pavia, Paolo Invernizzi, Gianni Turcato, Stefano Forlivesi, Elisa Francesca Maria Ciceri, Bruno Bonetti, Domenico Inzitari and Danilo Toni in International Journal of Stroke</p
IER-START nomogram for prediction of three-month unfavorable outcome after thrombectomy for stroke
No full textBACKGROUND:
The applicability of the current models for predicting functional outcome after thrombectomy in strokes with large vessel occlusion (LVO) is affected by a moderate predictive performance.
AIMS:
We aimed to develop and validate a nomogram with pre- and post-treatment factors for prediction of the probability of unfavorable outcome in patients with anterior and posterior LVO who received bridging therapy or direct thrombectomy <6 h of stroke onset.
METHODS:
We conducted a cohort study on patients data collected prospectively in the Italian Endovascular Registry (IER). Unfavorable outcome was defined as three-month modified Rankin Scale (mRS) score 3-6. Six predictors, including NIH Stroke Scale (NIHSS) score, age, pre-stroke mRS score, bridging therapy or direct thrombectomy, grade of recanalization according to the thrombolysis in cerebral ischemia (TICI) grading system, and onset-to-end procedure time were identified a priori by three stroke experts. To generate the IER-START, the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed by using the area under the receiver operating characteristic curve (AUC-ROC).
RESULTS:
A total of 1802 patients with complete data for generating the IER-START was randomly dichotomized into training ( n = 1219) and test ( n = 583) sets. The AUC-ROC of IER-START was 0.838 (95% confidence interval [CI]): 0.816-0.869) in the training set, and 0.820 (95% CI: 0.786-0.854) in the test set.
CONCLUSIONS:
The IER-START nomogram is the first prognostic model developed and validated in the largest population of stroke patients currently candidates to thrombectomy which reliably calculates the probability of three-month unfavorable outcome
Complications of mechanical thrombectomy for acute ischemic stroke: Incidence, risk factors, and clinical relevance in the Italian Registry of Endovascular Treatment in acute stroke
No full textBackground
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
General Anesthesia Versus Conscious Sedation and Local Anesthesia During Thrombectomy for Acute Ischemic Stroke
No full textAs numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA)
Predictors for hemorrhagic transformation and cerebral edema in stroke patients with first-pass complete recanalization
No full textBackground: Predictors of radiological complications attributable to reperfusion injury remain unknown when baseline setting is optimal for endovascular treatment and procedural setting is the best in stroke patients with large vessel occlusion (LVO). Aims: To identify clinical and radiological/procedural predictors for hemorrhagic transformation (HT) and cerebral edema (CED) at 24 hr in patients obtaining complete recanalization in one pass of thrombectomy for ischemic stroke ⩽ 6 h from symptom onset with intra-cranial anterior circulation LVO and ASPECTS ⩾ 6. Methods: We conducted a cohort study on prospectively collected data from 1400 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: HT was reported in 248 (18%) patients and early CED was reported in 260 (19.2%) patients. In the logistic regression model including predictors from a first model with clinical variables and from a second model with radiological/procedural variables, diabetes mellitus (odds ratio (OR) = 1.832, 95% confidence interval (CI) = 1.201-2.795), higher National Institutes of Health Stroke Scale (NIHSS) (OR = 1.076, 95% CI = 1.044-1.110), lower Alberta Stroke Program Early CT (ASPECTS) (OR = 0.815, 95% CI = 0.694-0.957), and longer onset-to-groin time (OR = 1.005, 95% CI = 1.002-1.007) were predictors of HT, whereas general anesthesia was inversely associated with HT (OR = 0.540, 95% CI = 0.355-0.820). Higher NIHSS (OR = 1.049, 95% CI = 1.021-1.077), lower ASPECTS (OR = 0.700, 95% CI = 0.613-0.801), intravenous thrombolysis (OR = 1.464, 95% CI = 1.061-2.020), longer onset-to-groin time (OR = 1.002, 95% CI = 1.001-1.005), and longer procedure time (OR = 1.009, 95% CI = 1.004-1.015) were predictors of early CED. After repeating a fourth logistic regression model including also good collaterals, the same variables remained predictors for HT and/or early CED, except diabetes mellitus and thrombolysis, while good collaterals were inversely associated with early CED (OR = 0.385, 95% CI = 0.248-0.599). Conclusions: Higher NIHSS, lower ASPECTS, and longer onset-to-groin time were predictors for both HT and early CED. General anesthesia and good collaterals were inversely associated with HT and early CED, respectively. Longer procedure time was predictor of early CED
Sex differences in outcome after thrombectomy for acute ischemic stroke. A propensity score-matched study
No full textBACKGROUND 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. RESULTS: Among 3422 patients included in the study, 1801 (52.6%) were women. Despite older age at onset (mean 72.4 vs 68.7; p < 0.001), and higher rate of atrial fibrillation (41.7% vs 28.6%; p < 0.001), women had higher probability of 3-month functional independence (adjusted odds ratio-adjOR 1.19; 95% CI 1.02–1.38), of complete recanalization (adjOR 1.25; 95% CI 1.09–1.44) and lower probability of death (adjOR 0.75; 95% CI 0.62–0.90). After propensity-score matching, a well-balanced cohort comprising 1150 men and 1150 women was analyzed, confirming the same results regarding functional outcome (3-month functional independence: OR 1.25; 95% CI 1.04–1.51), and complete recanalization (OR 1.29; 95% CI 1.09–1.53). CONCLUSIONS: Subject to the limitations of a non-randomized comparison, women with stroke due to LVO treated with mechanical thrombectomy had a better chance to achieve complete recanalization, and 3-month functional independence than men. The results could be driven by women who underwent combined treatment
IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke
No full textBackground and Purpose-As a reliable scoring system to detect the risk of symptomatic intracerebral hemorrhage after thrombectomy for ischemic stroke is not yet available, we developed a nomogram for predicting symptomatic intracerebral hemorrhage in patients with large vessel occlusion in the anterior circulation who received bridging of thrombectomy with intravenous thrombolysis (training set), and to validate the model by using a cohort of patients treated with direct thrombectomy (test set).Methods-We conducted a cohort study on prospectively collected data from 3714 patients enrolled in the IER (Italian Registry of Endovascular Stroke Treatment in Acute Stroke). Symptomatic intracerebral hemorrhage was defined as any type of intracerebral hemorrhage with increase of >= 4 National Institutes of Health Stroke Scale score points from baseline <= 24 hours or death. Based on multivariate logistic models, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve.Results-National Institutes of Health Stroke Scale score, onset-to-end procedure time, age, unsuccessful recanalization, and Careggi collateral score composed the IER-SICH nomogram. After removing Careggi collateral score from the first model, a second model including Alberta Stroke Program Early CT Score was developed. The area under the receiver operating characteristic curve of the IER-SICH nomogram was 0.778 in the training set (n=492) and 0.709 in the test set (n=399). The area under the receiver operating characteristic curve of the second model was 0.733 in the training set (n=988) and 0.685 in the test set (n=779).Conclusions-The IER-SICH nomogram is the first model developed and validated for predicting symptomatic intracerebral hemorrhage after thrombectomy. It may provide indications on early identification of patients for more or less postprocedural intensive management
