Federica Ferrari
@mondino.it
Neurology Resident, Medical Assistant - Stroke Unit and Emergency Neurology
IRCCS Mondino Foundation
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Maria Magdalena Pocora, Micol Avenali, Michele Giovanni Croce, Federica Ferrari, Francesca Valentino, Claudio Pacchetti, Cristina Tassorelli, and Roberta Zangaglia
Wiley
Carmelo Tiberio Currò, Federica Ferrari, Giovanni Merlino, Stefan Moraru, Francesco Bax, Fedra Kuris, Lorenzo Nesi, Mariarosaria Valente, Elena Ballante, Nicola d’Altilia,et al.
Springer Science and Business Media LLC
Abstract Aim To evaluate the relationship of early neurological deterioration (END) with admission glycemia (aG) and new stress hyperglycemia indexes in spontaneous intracerebral hemorrhage (ICH) patients. Methods The present retrospective study included 171 ICH patients from two stroke centers. END was defined as an increase ≥ 4 points in National Institutes of Health Stroke Scale and/or a decrease ≥ 2 points in Glasgow Coma Scale within 72 hours from admission. The included stress hyperglycemia indexes were glycemic gap (GGAP), stress hyperglycemia ratio (SHR), and glucose-glycated hemoglobin ratio. GGAP was calculated as aG – 28,7*glycated hemoglobin + 46,7; SHR as aG / (28,7*glycated hemoglobin – 46,7); Glucose-glycated hemoglobin ratio as aG / glycated hemoglobin. We performed univariate and multivariate analyses for END. The receiver operating characteristic curves were built for END-related glycemic measures; area under curves (AUC) were calculated and compared. The optimized threshold values were calculated, and significant glycemic measures were dichotomized. Univariate and multivariate analyses were performed for the dichotomized measures. Results END was present in 21 patients (12.3%) and was significantly associated with GGAP, SHR and glucose-glycated hemoglobin ratio, but not with aG. The AUC of the three stress hyperglycemia indexes did not differ significantly. The optimized cutoffs were 35.68 (sensitivity 0.47, specificity 0.81), 1.15 (sensitivity 0.62, specificity 0.68), and 26.67(sensitivity 0.43, specificity 0.80) for GGAP, SHR, and glucose-glycated hemoglobin ratio respectively. END was also associated with all stress hyperglycemia indexes expressed as categorical variables. Conclusion GGAP, SHR, and glucose-glycated hemoglobin ratio were predictors of END in ICH patients.
Karthik Venkatakrishnan, Jing ‘Daisy’ Zhu, Federica Ferrari, Krista Levy, and Beth Kennedy
Wiley
AbstractResilience is a critical leadership competency directly linked to engagement, sustainable innovation, and productivity. This Commentary presents resilience concepts using the Benatti Resiliency Model®, which comprises five inter‐related dimensions: Well‐being, Self‐awareness, Brand, Connection, and Innovation. Trust is discussed as a critical leadership competency, with three levels: self‐trust, trust in relationships at the team level, and community trust. The concept of Ikigai, representing the intersection of what one loves, what one is good at, what the world needs, and what one can be paid for, is discussed as a framework for self‐awareness, brand development, development planning, and mentoring. Time and energy management using the Eisenhower matrix is highlighted as a strategy to build resilience, manage stress, enhance productivity, and prevent burnout. Taken together, the strategies discussed in this commentary are intended to unlock the transformative potential of resilience for sustainable innovation and impact within and beyond the dynamic and interdisciplinary field of clinical pharmacology, ultimately enabling professional success and personal fulfillment.
Federico Mazzacane, Stefan Moraru, Beatrice Del Bello, Federica Ferrari, Erica Ferro, Alessandra Persico, Jawed Nawabi, Alessandro Padovani, Anna Cavallini, and Andrea Morotti
Wiley
AbstractBackgroundMedial intracranial carotid artery calcifications (ICAC) are associated with impaired vascular physiology, increased arterial stiffness and pulse pressure. Their presence might therefore be associated with increased risk of intracerebral hemorrhage (ICH) expansion, according to the avalanche model. We explored the association between ICAC presence and pattern and hematoma expansion (HE).MethodsRetrospective analysis of a monocentric, prospectively collected cohort of ICH patients admitted between June 2017 and October 2023. ICAC pattern was determined by Kockelkoren's rating scale on admission CT; medial ICAC were defined with a >6 points cutoff. A follow‐up CT scan was performed within 72 h. HE was analyzed as a dichotomous (≥6 mL and/or ≥33%) and as a categorical (none/mild/moderate/severe) variable, and its predictors were explored with logistic and ordinal regression respectively, accounting for baseline volume, onset‐to‐CT time, and anticoagulation. All the analyses were stratified by ICH location (supratentorial deep vs lobar ICH).ResultsA total of 201 patients were included (median age 78, 42% females, 59% deep ICH). Medial ICAC were significantly more common in deep ICH with HE compared with non‐expanders (72% vs 49%, p = 0.03), whereas there was no association between ICAC and HE in lobar ICH (53% vs 52%, p = 0.85). This association between medial ICAC and HE in deep ICH remained significant in logistic (aOR 3.11, 95% CI [1.19–9.06], p = 0.03) and ordinal regression (acOR 2.42, 95% CI [1.19–4.99], p = 0.01).InterpretationIpsilateral medial ICAC are associated with higher odds of HE in deep ICH. Our findings are best interpreted as hypothesis generating, requiring prospective validation and further research to characterize the underlying biological mechanisms.
Gloria Vaghi, Andrea Morotti, Elisa Maria Piella, Micol Avenali, Daniele Martinelli, Silvano Cristina, Marta Allena, Valentina Grillo, Michele Corrado, Federico Bighiani,et al.
Springer Science and Business Media LLC
AbstractStroke affects the interconnection between the nervous and immune systems, leading to a down-regulation of immunity called stroke-induced immunosuppression (SII). The primary aim of this study is to investigate SII role as a predictor of functional, neurological, and motor outcomes in the neurorehabilitation setting (NRB). We conducted a prospective observational study enrolling post-acute stroke patients hospitalized for neurorehabilitation. At NRB admission (T0) and discharge (T1), we assessed presence of SII (defined by a neutrophil-to-lymphocyte ratio ≥ 5) and we evaluated functional independence (Functional Independence Measure-FIM, Barthel Index-BI), motor performances (Tinetti Score, Hauser Ambulation Index) and neurological impairment (NIHSS). We enrolled 96 patients (45.8% females, 70.6 ± 13.9 years, 88.5% ischemic stroke). At T0, 15.6% of patients (15/96) had SII. When compared to immunocompetent patients (IC), the SII group was characterized by worse baseline functional independence, motor performances and neurological disability. The same was confirmed at T1 (FIM p = 0.012, BI p = 0.007, Tinetti p = 0.034, NIHSS p = 0.001). Neurological disability demonstrated a less pronounced improvement in SII (ΔNIHSS: SII: − 2.1 ± 2.3 vs. IC: − 3.1 ± 2.5, p = 0.035). SII group presented a higher percentage of infectious complications during the neurorehabilitation period (SII 80% vs. IC 25.9%; p = 0.001). SII may represent a negative prognostic factor in the neurorehabilitation setting. SII patients were characterized by poorer functional, motor, neurological performances and higher risk of infectious complications. ClinicaTrial registration: NCT05889169.
Roberto Federico Villa, Federica Ferrari, and Antonella Gorini
Springer Science and Business Media LLC
Sarah Cargnin, Federica Ferrari, and Salvatore Terrazzino
Springer Science and Business Media LLC
Abstract Purpose Inconclusive and limited results have been reported on the clinical utility of CYP2C19 genotyping in stroke/TIA patients of non-East Asian ancestries. We herein performed an updated systematic review and meta-analysis to quantitatively estimate the association of CYP2C19 loss-of function (LOF) status with efficacy and safety of clopidogrel-based antiplatelet therapy in non-East Asian patients affected by stroke or TIA. Methods A comprehensive search was performed up to July 2023 using PubMed, Web of Knowledge, and Cochrane Library databases. The clinical outcomes investigated were stroke, composite vascular events and bleeding. Pooled estimates were calculated as risk ratios (RR) with 95% CI using the Mantel– Haenszel random-effects model. The quality of evidence was assessed using the GRADEpro tool. Results A total number of 1673 stroke/TIA patients from 8 non-East Asian studies, published between 2014 and 2022, were included in the systematic review. Clopidogrel-treated carriers of CYP2C19 LOF alleles were found at increased risk of stroke compared to non-carriers (RR: 1.68, 95%CI: 1.04–2.71, P = 0.03). However, no significant association was observed with the risk of composite vascular events (RR: 1.15, 95%CI: 0.58–2.28, P = 0.69) or bleeding (RR: 0.84, 95%CI: 0.38–1.86, P = 0.67). Similarly, European ancestry patients carrying CYP2C19 LOF alleles displayed a higher risk of stroke (RR: 2.69 (1.11–6.51, P = 0.03), but not of composite vascular events or bleeding. Conclusion The present updated meta-analysis provides moderate quality evidence of association between CYP2C19 LOF alleles and an increased risk of stroke in non-East Asian patients with stroke/TIA after receiving clopidogrel therapy. Further large pharmacogenetic studies are still warranted to corroborate these findings.
F. Mazzacane, F. Ferrari, A. Malvaso, Y. Mottese, M. Gastaldi, A. Costa, A. Pichiecchio, and A. Cavallini
Frontiers Media SA
IntroductionAcute amnestic syndrome is an uncommon clinical presentation of neurological disease. Differential diagnosis encompasses several syndromes including Wernicke-Korsakoff and transient global amnesia (TGA). Structural lesions of the fornix account for a minority of cases of acute amnestic syndromes. Etiology varies from iatrogenic injury to ischemic, inflammatory, or neoplastic lesions. A prompt diagnosis of the underlying pathology is essential but challenging. The aim of this review is to systematically review the existing literature regarding cases of acute amnestic syndrome associated with non-iatrogenic lesions of the fornix.MethodsWe performed a systematic literature search on PubMed, Scopus, and Web of Science up to September 2023 to identify case reports and case series of patients with amnestic syndrome due to fornix lesions. The systematic review was conducted according to PRISMA guidelines. The research was limited to articles written in English. Cases of fornix damage directly ascribable to a surgical procedure were excluded.ResultsA total of 52 publications reporting 55 cases were included in the review. Focusing on acute/subacute onset, vascular etiology was highly prevalent, being responsible for 78% of cases, 40/55 (74%) of which were due to acute ischemic stroke. The amnestic syndrome was characterized by anterograde amnesia in all patients, associated with retrograde amnesia in 27% of cases. Amnesia was an isolated presentation in most cases. Up to two thirds of patients had persistent memory deficits of any severity at follow-up.DiscussionAcute amnestic syndrome can be rarely caused by fornix lesions. In most cases of acute/subacute presentation, the etiology is ischemic stroke, mainly caused by strokes involving the subcallosal artery territory. The differential diagnosis is challenging and a distinction from common mimics is often difficult on a clinical basis. A high index of suspicion should be maintained to avoid misdiagnosis and provide adequate acute treatment to patients with time-dependent disease, also employing advanced neuroimaging. More research is needed to better understand the outcome and identify prognostic factors in patients with amnestic syndrome due to fornix lesions.
Federica Ferrari, Daniela Rossi, Alessandra Ricciardi, Carlo Morasso, Liliana Brambilla, Sara Albasini, Renzo Vanna, Chiara Fassio, Tatjana Begenisic, Marianna Loi,et al.
SAGE Publications
Identification of reliable and accessible biomarkers to characterize ischemic stroke patients’ prognosis remains a clinical challenge. Neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) are markers of brain injury, detectable in blood by high-sensitive technologies. Our aim was to measure serum NfL and GFAP after stroke, and to evaluate their correlation with functional outcome and the scores in rehabilitation scales at 3-month follow-up. Stroke patients were prospectively enrolled in a longitudinal observational study within 24 hours from symptom onset (D1) and monitored after 7 (D7), 30 ± 3 (M1) and 90 ± 5 (M3) days. At each time-point serum NfL and GFAP levels were measured by Single Molecule Array and correlated with National Institute of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), Trunk Control Test (TCT), Functional Ambulation Classification (FAC) and Functional Independence Measure (FIM) scores. Serum NfL and GFAP showed different temporal profiles: NfL increased after stroke with a peak value at D7; GFAP showed an earlier peak at D1. NfL and GFAP concentrations correlated with clinical/rehabilitation outcomes both longitudinally and prospectively. Multivariate analysis revealed that NfL-D7 and GFAP-D1 were independent predictors of 3-month NIHSS, TCT, FAC and FIM scores, with NfL being the biomarker with the best predictive performance.
Federico Mazzacane, Beatrice Del Bello, Federica Ferrari, Alessandra Persico, Elisa Rognone, Anna Pichiecchio, Alessandro Padovani, Anna Cavallini, Andrea Morotti, and Francesco Arba
Wiley
AbstractBackground and purposeIntracranial carotid artery calcifications (ICACs) are a common finding on noncontrast computed tomography (NCCT) and have been associated with an increased risk of ischemic stroke. However, no data are available about the association between ICAC patterns and stroke etiology. We investigated the association between ICAC patterns and etiological subtypes of ischemic stroke.MethodsWe retrospectively analyzed a single center cohort of patients admitted for ischemic stroke with known etiology. Each carotid artery was evaluated separately on NCCT scans to define the ICAC pattern (intimal, medial, mixed). The association between ICAC patterns and stroke etiology was investigated using logistic regression models adjusting for relevant confounders.ResultsA total of 485 patients were included (median age = 78 [interquartile range (IQR) = 70–85] years, 243 [50%] female, median National Institutes of Health Stroke Scale = 6 [IQR = 3–12]). Frequencies of ICAC patterns were: intimal, n = 96 (20%); medial, n = 273 (56%); mixed, n = 51 (11%), indistinct/absent, n = 65 (13%) patients. Intimal pattern was more frequent in lacunar compared with nonlacunar (33% vs. 16%, p < 0.001) stroke etiology, whereas medial pattern was less frequent in lacunar compared with nonlacunar stroke (36% vs. 62%, p < 0.001). After adjustment for confounders, intimal ICAC predominant pattern remained associated with lacunar stroke etiology in two multivariate models (Model 1: adjusted odds ratio [aOR] = 2.08, 95% confidence interval [CI] = 1.20–3.56; Model 2: aOR = 2.01, 95% CI = 1.16–3.46).ConclusionsOur study suggests that intimal ICAC pattern is associated with lacunar stroke and may serve as a marker for lacunar stroke etiology, possibly strengthening the relation between endothelial dysfunction and lacunar stroke.
Federica Ferrari and Roberto Federico Villa
Elsevier BV
Federica Ferrari, Antonio Moretti, and Roberto Federico Villa
Elsevier BV
Roberto Federico Villa, Antonella Gorini, and Federica Ferrari
Springer Science and Business Media LLC
RobertoFederico Villa, Federica Ferrari, and Antonio Moretti
Medknow
Diabetes mellitus and associated chronic hyperglycemia enhance the risk of acute ischemic stroke and lead to worsened clinical outcome and increased mortality. However, post-stroke hyperglycemia is also present in a number of non-diabetic patients after acute ischemic stroke, presumably as a stress response. The aim of this review is to summarize the main effects of hyperglycemia when associated to ischemic injury in acute stroke patients, highlighting the clinical and neurological outcomes in these conditions and after the administration of the currently approved pharmacological treatment, i.e. insulin. The disappointing results of the clinical trials on insulin (including the hypoglycemic events) demand a change of strategy based on more focused therapies. Starting from the comprehensive evaluation of the physiopathological alterations occurring in the ischemic brain during hyperglycemic conditions, the effects of various classes of glucose-lowering drugs are reviewed, such as glucose-like peptide-1 receptor agonists, DPP-4 inhibitors and sodium glucose cotransporter 2 inhibitors, in the perspective of overcoming the up-to-date limitations and of evaluating the effectiveness of new potential therapeutic strategies.
Roberto Federico Villa and Federica Ferrari
Elsevier
A. Cervo, F. Ferrari, G. Barchetti, L. Quilici, M. Piano, E. Boccardi, and G. Pero
American Society of Neuroradiology (ASNR)
BACKGROUND AND PURPOSE: In cases of large-vessel-occlusion strokes due to an underlying tandem internal carotid artery occlusion or intracranial atherosclerotic disease, concomitant stent placement may be needed. Immediate platelet inhibition is necessary, but to date, a standardized approach for antiplatelet inhibition in acute settings is still missing. Here we report our single-center experience about the safety and efficacy of periprocedural administration of cangrelor in patients with acute ischemic stroke due to intracranial or cervical artery occlusion undergoing stent placement. MATERIALS AND METHODS: We retrospectively evaluated all cases of acute ischemic stroke that needed acute stent implantation and were treated with periprocedural administration of cangrelor between January 2019 and April 2020 at our institution. All patients who needed either extracranial or intracranial artery stent placement (in either the anterior or posterior circulation) were included. RESULTS: We evaluated 38 patients in whom cangrelor was administered IV periprocedurally. Their mean age was 64 years (range, 26–85 years), with 25/38 male subjects and 13/38 female patients. In 26 patients (68.4%), a tandem occlusion was present and was treated with carotid artery stent placement, while 12 patients (31.6%) required an intracranial stent implantation. In 4 subjects (10.5%), an intracerebral hemorrhage occurred after the procedure. All patients in the series were alive 1 week after the procedure. CONCLUSIONS: Although larger, multicentric randomized studies are strongly warranted, our results support the hypothesis of a possible role of cangrelor as a valuable therapeutic option in the management of platelet inhibition in acute ischemic stroke procedures after intra- or extracranial stent placement.
Federica Ferrari, Antonio Moretti, and Roberto Federico Villa
Elsevier BV
Federica Ferrari, Paola Viscardi, Antonella Gorini, and Roberto Federico Villa
Elsevier BV
Federica Ferrari, Antonella Gorini, Siegfried Hoyer, and Roberto Federico Villa
Wiley
AbstractGlutamate is involved in cerebral ischemic injury, but its role has not been completely clarified and studies are required to understand how to minimize its detrimental effects, contemporarily boosting the positive ones. In fact, glutamate is not only a neurotransmitter, but primarily a key metabolite for brain bioenergetics. Thus, we investigated the relationships between glutamate and brain energy metabolism in an in vivo model of complete cerebral ischemia of 15 min and during post‐ischemic recovery after 1, 24, 48, 72, and 96 h in 1‐year‐old adult and 2‐year‐old aged rats. The maximum rates (Vmax) of glutamate dehydrogenase (GlDH), glutamate‐oxaloacetate transaminase, and glutamate‐pyruvate transaminase were assayed in somatic mitochondria (FM) and in intra‐synaptic ‘Light’ mitochondria and intra‐synaptic ‘Heavy’ mitochondria ones purified from cerebral cortex, distinguishing post‐ and pre‐synaptic compartments. During ischemia, none of the enzymes were modified in adult animals. In aged ones, glutamate‐oxaloacetate transaminase was increased in FM and GlDH in intra‐synaptic ‘Heavy’ mitochondria, stimulating glutamate catabolism. During post‐ischemic recovery, FM did not show modifications at both ages while, in intra‐synaptic mitochondria of adult animals, glutamate catabolism was increased after 1 h of recirculation and decreased after 48 and 72 h, whereas it remained decreased up to 96 h in aged rats. These results, with those previously published about Krebs’ cycle and Electron Transport Chain (Villa et al., [2013] Neurochem. Int. 63, 765–781), demonstrate that: (i) Vmax of energy‐linked enzymes are different in the various cerebral mitochondria, which (ii) respond differently to ischemia and post‐ischemic recovery, also (iii) with respect to aging. image
Roberto Federico Villa, Federica Ferrari, and Antonio Moretti
Elsevier BV
F. Ferrari and R. F. Villa
Springer Science and Business Media LLC
Roberto Federico Villa, Federica Ferrari, Laura Bagini, Antonella Gorini, Nicoletta Brunello, and Fabio Tascedda
Elsevier BV
Roberto Federico Villa, Federica Ferrari, Antonella Gorini, Nicoletta Brunello, and Fabio Tascedda
Elsevier BV
Antonio Moretti, Federica Ferrari, and Roberto F. Villa
Elsevier BV
Federica Ferrari, Antonella Gorini, and Roberto Federico Villa
Elsevier BV