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    Oral Communication

    Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies

    Thrombotic Thrombocytopenic Purpura (TTP): Molecular and Clinical

    OC 26.3 - Main features of ischemic stroke in patients with acute immune-mediated thrombotic thrombocytopenic purpura

    Sunday, June 25, 2023
    15:15 – 15:30 ET
    Room: 510
    Session Available As: On-Demand

      Presenting Author(s)

    • Addolorata Truma, MD

      Resident doctor in Internal Medicine
      Università degli Studi di Milano, Department of Pathophysiology and Transplantation
      Milano, Lombardia, Italy

      • Co-Author(s)

    • Pasquale Agosti, MD, PhD

      Università degli Studi di Milano, Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Milan, Italy
      Milano, Lombardia, Italy

    • Andrea Artoni, MD

      MD
      Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
      Milano, Lombardia, Italy

    • NG

      Nicole Galli

      Resident doctor
      Università degli studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy
      Milan, Lombardia, Italy

    • Juri Alessandro Giannotta, MD

      Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
      Milano, Lombardia, Italy

    • PD

      Pasqualina De Leo

      Biologist
      Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
      Milan, Lombardia, Italy

    • BF

      Barbara Ferrari

      MD
      Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
      Milan, Lombardia, Italy

    • IM

      Ilaria Mancini, PhD

      Post-Doc Research Fellow
      Università degli Studi di Milano, Department of Pathophysiology and Transplantation and Fondazione Luigi Villa, Milan, Italy
      Milan, Lombardia, Italy

    • Flora Peyvandi, MD, PhD (she/her/hers)

      Director
      IRCCS Ca' Granda Maggiore Hospital Foundation, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milano, Italy; Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milano, Italy
      Milano, Lombardia, Italy

    Background: Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a life-threatening thrombotic microangiopathy often characterized by acute neurological involvement. However, neuroimaging patterns, epidemiology and risk factors of ischemic stroke (IS) in iTTP are largely unknown.

    Aims: To evaluate neuroimaging patterns and main related risk factors of ischemic stroke in acute iTTP.

    Methods: We performed a cross-sectional study of patients from the Milan TTP Registry who presented with neurological signs/symptoms and underwent a brain imaging during their first acute iTTP episode. Patients with history of IS were excluded.

    Results: Seventy-four patients were enrolled, most of patients were women (72%) and of Caucasian ethnicity (98%), with a median age of 45 years. Computed tomography (CT) was performed in all patients, whereas magnetic resonance imaging (MRI) in 20 patients (27%). IS was confirmed by CT and/or MRI in 17 patients (23%), the majority (70%) showed a non-lacunar pattern. In patients who underwent both CT and MRI (n=12), MRI detected an IS in 5 patients with negative CT scans and multiple ischemic lesions in 3 patients with one single lesion on CT (Table 1). The median age was slightly higher in patients with IS (44 vs 48 years), whereas the prevalence of cardiovascular risk factors and iTTP-associated parameters were comparable between the two groups (Table 2).

    Conclusion(s): We found a 23% prevalence of imaging-proven ischemic stroke in patients presenting with neurological manifestations at their first acute iTTP episode. Cardiovascular risk factors and iTTP-laboratory parameters were not associated with an increased IS risk. The unexpected high prevalence of non-lacunar and bilateral stroke patterns needs further investigation. The higher sensitivity of MRI than CT in detecting ischemic lesions might suggest the usefulness of this technique in the setting of acute iTTP.

    Learning Objectives:

    • clarify the risk of ischemic stroke of patients with thrombotic thrombocytopenic purpura during the acute phase
    • identify patients with thrombotic thrombocytopenic purpura during the acute phase that could benefit from advanced imaging studies
    • improve the management of patients with thrombotic thrombocytopenic purpura during the acute phase and during remission