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CompletedNCT06935578ALIGNEDUpdated Sep 1, 2026

RAre, But Not aLone: a Large Italian Network to Empower the Impervious diaGNostic Pathway of Rare cerEbrovascular Diseases (ALIGNED)

An observational study in CADASIL, CADASIL (Diagnosis) and Moya Moya Disease, sponsored by Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta. Completed at 17 sites in Italy. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-01.

Sponsored by Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta · Observational

Study type
Observational
Model
Cohort
Time perspective
Prospective
Enrollment
500
Ages
18 Years and older
Sex
All
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Study summary

Cerebrovascular diseases (CVDs) are one leading cause of morbidity and mortality worldwide. Despite intensive investigations, more than 30% of strokes remain of undetermined origin. Rare Cerebrovascular Diseases (rCVDs), including heritable (i.e., CADASIL, COL4A1 syndrome, Fabry disease) and acquired conditions (i.e., Sneddon syndrome, Moyamoya arteriopathy) account for a proportion of these strokes. However, rCVDs are often misdiagnosed since clinicians are not able to recognize them. Although rare, the identification of these stroke causes is important to establish appropriate management measures, including genetic counselling, and, if available, therapy. The lack of data on phenotype and clinical course of rCVDs, given the paucity of published series, makes the diagnosis and the development of therapies challenging. Furthermore, the molecular characterization of rCVDs is still lacking, despite progresses achieved in common stroke by applying high throughput approaches as multi-omics. Since the diagnosis and care of rCVDs require adequate expertise and instrumental tools, clinical and research activities are usually reserved to few specialized centers, mostly located in the North of Italy, leading patients to expensive trips for consultations. Therefore, the creation of a clinical and research network aimed at improving the diagnostic pathways of rCVDs is highly needed to improve the number of patients with rCVDs to better define the clinical phenotype and to transfer the knowledge on rCVDs in other centers overall Italy filling the geographical gap affecting Southern Italy.

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Conditions studied

  • CADASIL
  • CADASIL (Diagnosis)
  • Moya Moya Disease
  • Moyamoya
  • Moyamoya Syndrome
  • Sneddon Syndrome
  • Fabry Disease
  • COL4A1\2

Keywords

  • Rare Cerebrovascular Diseases
  • italian network
  • CADASIL
  • COL4A1 syndrome
  • Fabry Disease
  • Sneddon Syndrome
  • Moyamoya arteriopathy
  • COL4A1/2
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In context

CADASIL

33 studies on the registry are indexed under CADASIL; 18 are open to participants now.

This study's enrollment of 500 is above the median of 168 across 22 observational studies indexed under CADASIL.

Browse CADASIL studies →

Lead sponsor

Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta is the lead sponsor of 84 studies on the registry; 32 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No
Sampling method
Non-probability sample

Study population

Adults, male and female patients affected by a Rare Cerebrovascular Disease (rCVD)

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • patients with a clinical, genetic and/or neuroradiological diagnosis of rCVD (CADASIL, Fabry's disease, COL4A1, Sneddon's syndrome or Moyamoya arteriopathy), who have had at least one brain MRI study;

Exclusion criteria

Exclusion Criteria:

  • na
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Study design

Observational model
Cohort
Time perspective
Prospective
Enrollment
500 participants (actual)
Patient registry
No
06

What researchers measure

Primary outcomes

  1. Describe the phenotypic characteristics of rCVD patients

    To describe the phenotypic characteristics of rCVD patients. All patients will complete a standardized neurological assessment consisting of anamnestic data collection (family history of neurological pathology, and in particular of rCVD, cardiovascular risk factors, medications taken, comorbidities, recent or previous head injuries) and a complete physical examination.

    Time frame: 0-12 months

  2. Assess the natural history of disease

    To develop a new, unique, and large registry on rCVDs recruiting a large number of patients (500) , patients will be recruited by all the participating clinical centers

    Time frame: 0-12 months

Secondary outcomes

  1. Identify the molecular mechanisms

    Identify the molecular mechanisms underlying rCVD, targeted/quantitative approaches will validate the emerged key molecular features (e.g by transcriptomic, proteomic, metabolomic, and lipidomic approaches).

    Time frame: 12-30 months

  2. Identify biomarkers

    Identify reliable and usable circulating biomarkers for the diagnosis of rCVD by applying mass spectrometry-based cutting-edge technologies for an unbiased identification of differentially abundant candidates (e.g. proteins or metabolites), and for their validation and simultaneous assessment in multi-marker panels

    Time frame: 12-30 months

  3. Provide the best clinical and therapeutic management

    Implement the virtual multi-specialty and multicenter rCVD case-sharing model in order to provide the best clinical and therapeutic management of the patients taken in. A team of specialists with expertise in each rCVD, comprising neurologists, neurosurgeons, neuro-radiologists, interventional radiologists, neuropsychiatrists, geneticists, neurophysiologists and/or psychologists, will schedule virtual monthly meetings to discuss the diagnosis and provide individual patients with the best diagnostic and management paths. A specific platform for second opinion consultations will be created by using the existing telemedicine platform.

    Time frame: 12-30 months

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Study locations

17 sites
  • Ospedale Regionale Generale "F. Miulli", Acquaviva delle Fonti
    Acquaviva delle Fonti, BA, Italy
  • ASST Melegnano Martesana
    Melegnano, MI, Italy
  • Neurologia Stroke Unit dell'Asst Rhodense
    Rho, Mi, Italy
  • Fondazione Istituto G. Giglio, Cefalù
    Cefalù, PA, Italy
  • UO Neurologia degli Ospedali di Cesena e Forlì, Ospedale Bufalini Cesena ed Ospedale Morgagni-Pierantoni (Ausl della Romagna)
    Cesena, Italy
  • ASST di Cremona
    Cremona, Italy
  • Ospedale "Spaziani" di Frosinone
    Frosinone, Italy
  • U.O. Neurologia, Ospedale Sant'Andrea, La Spezia
    La Spezia, Italy
  • ASST Grande Ospedale Metropolitano Niguarda
    Milan, Italy
  • Fondazione IRCCS Istituto Neurologico Carlo Besta
    Milan, Italy
  • Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco
    Milan, Italy
  • Stroke Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano
    Milan, Italy
  • IRCCS Policlinico San Matteo, Pavia
    Pavia, Italy
  • Neurologia d'Urgenza e Stroke Unit dell'Ospedale di Pescara
    Pescara, Italy
  • Neurologia dell'Ospedale Sandro Pertini - ASL Roma2
    Roma, Italy
  • Policlinico Tor Vergata, UOSD Stroke Unit
    Roma, Italy
  • Neurologia PO Levante Asl 2 Savonese
    Savona, Italy
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References and documents

Publications

  • Caponnetto V, Ornello R, De Matteis E, Papavero SC, Fracasso A, Di Vito G, Lancia L, Ferrara FM, Sacco S. The COVID-19 Pandemic as an Opportunity to Improve Health Care Through a Nurse-Coordinated Multidisciplinary Model in a Headache Specialist Center: The Implementation of a Telemedicine Protocol. Telemed J E Health. 2022 Jul;28(7):1016-1022. doi: 10.1089/tmj.2021.0414. Epub 2021 Nov 9. PubMed 34756108 ↗
  • Banfi C, Baetta R, Barbieri SS, Brioschi M, Guarino A, Ghilardi S, Sandrini L, Eligini S, Polvani G, Bergman O, Eriksson P, Tremoli E. Prenylcysteine oxidase 1, an emerging player in atherosclerosis. Commun Biol. 2021 Sep 21;4(1):1109. doi: 10.1038/s42003-021-02630-z. PubMed 34548610 ↗
  • Degan D, Ornello R, Tiseo C, De Santis F, Pistoia F, Carolei A, Sacco S. Epidemiology of Transient Ischemic Attacks Using Time- or Tissue-Based Definitions: A Population-Based Study. Stroke. 2017 Mar;48(3):530-536. doi: 10.1161/STROKEAHA.116.015417. Epub 2017 Jan 31. PubMed 28143922 ↗
  • Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke. 2009 Feb;40(2):394-9. doi: 10.1161/STROKEAHA.108.523209. Epub 2008 Nov 26. PubMed 19038914 ↗
  • Romani I, Nencini P, Sarti C, Pracucci G, Zedde M, Nucera A, Cianci V, Moller J, Toni D, Orsucci D, Casella C, Pinto V, Palumbo P, Barbarini L, Bella R, Ragno M, Scoditti U, Mezzapesa DM, Tassi R, Diomedi M, Cavallini A, Volpi G, Chiti A, Bigliardi G, Sacco S, Linoli G, Ricci S, Giordano A, Bonetti B, Rasura M, Cecconi E, Princiotta Cariddi L, Curro Dossi R, Melis M, Consoli D, Guidetti D, Biagini S, Accavone D, Inzitari D. Fabry-Stroke Italian Registry (FSIR): a nationwide, prospective, observational study about incidence and characteristics of Fabry-related stroke in young-adults. Presentation of the study protocol. Neurol Sci. 2022 Apr;43(4):2433-2439. doi: 10.1007/s10072-021-05615-2. Epub 2021 Oct 5. PubMed 34609660 ↗
  • Bersano A, Markus HS, Quaglini S, Arbustini E, Lanfranconi S, Micieli G, Boncoraglio GB, Taroni F, Gellera C, Baratta S, Penco S, Mosca L, Grasso M, Carrera P, Ferrari M, Cereda C, Grieco G, Corti S, Ronchi D, Bassi MT, Obici L, Parati EA, Pezzini A, De Lodovici ML, Verrengia EP, Bono G, Mazucchelli F, Zarcone D, Calloni MV, Perrone P, Bordo BM, Colombo A, Padovani A, Cavallini A, Beretta S, Ferrarese C, Motto C, Agostoni E, Molini G, Sasanelli F, Corato M, Marcheselli S, Sessa M, Comi G, Checcarelli N, Guidotti M, Uccellini D, Capitani E, Tancredi L, Arnaboldi M, Incorvaia B, Tadeo CS, Fusi L, Grampa G, Merlini G, Trobia N, Comi GP, Braga M, Vitali P, Baron P, Grond-Ginsbach C, Candelise L; Lombardia GENS Group*. Clinical Pregenetic Screening for Stroke Monogenic Diseases: Results From Lombardia GENS Registry. Stroke. 2016 Jul;47(7):1702-9. doi: 10.1161/STROKEAHA.115.012281. Epub 2016 May 31. PubMed 27245348 ↗
  • Bersano A, Bedini G, Markus HS, Vitali P, Colli-Tibaldi E, Taroni F, Gellera C, Baratta S, Mosca L, Carrera P, Ferrari M, Cereda C, Grieco G, Lanfranconi S, Mazucchelli F, Zarcone D, De Lodovici ML, Bono G, Boncoraglio GB, Parati EA, Calloni MV, Perrone P, Bordo BM, Motto C, Agostoni E, Pezzini A, Padovani A, Micieli G, Cavallini A, Molini G, Sasanelli F, Sessa M, Comi G, Checcarelli N, Carmerlingo M, Corato M, Marcheselli S, Fusi L, Grampa G, Uccellini D, Beretta S, Ferrarese C, Incorvaia B, Tadeo CS, Adobbati L, Silani V, Farago G, Trobia N, Grond-Ginsbach C, Candelise L; Lombardia GENS-group. The role of clinical and neuroimaging features in the diagnosis of CADASIL. J Neurol. 2018 Dec;265(12):2934-2943. doi: 10.1007/s00415-018-9072-8. Epub 2018 Oct 11. PubMed 30311053 ↗
  • Bersano A, Bedini G, Nava S, Acerbi F, Sebastiano DR, Binelli S, Franceschetti S, Farago G, Grisoli M, Gioppo A, Ferroli P, Bruzzone MG, Riva D, Ciceri E, Pantaleoni C, Saletti V, Esposito S, Nardocci N, Zibordi F, Caputi L, Marzoli SB, Zedde ML, Pavanello M, Raso A, Capra V, Pantoni L, Sarti C, Pezzini A, Caria F, Dell' Acqua ML, Zini A, Baracchini C, Farina F, Sanguigni S, De Lodovici ML, Bono G, Capone F, Di Lazzaro V, Lanfranconi S, Toscano M, Di Piero V, Sacco S, Carolei A, Toni D, Paciaroni M, Caso V, Perrone P, Calloni MV, Romani A, Cenzato M, Fratianni A, Ciusani E, Prontera P, Lasserve ET, Blecharz K, Vajkoczy P, Parati EA; GEN-O-MA study group. GEN-O-MA project: an Italian network studying clinical course and pathogenic pathways of moyamoya disease-study protocol and preliminary results. Neurol Sci. 2019 Mar;40(3):561-570. doi: 10.1007/s10072-018-3664-z. Epub 2019 Jan 3. PubMed 30604336 ↗
  • Bersano A, Morbin M, Ciceri E, Bedini G, Berlit P, Herold M, Saccucci S, Fugnanesi V, Nordmeyer H, Farago G, Savoiardo M, Taroni F, Carriero M, Boncoraglio Giorgio B, Perucca L, Caputi L, Parati Eugenio A, Kraemer M. The diagnostic challenge of Divry van Bogaert and Sneddon Syndrome: Report of three cases and literature review. J Neurol Sci. 2016 May 15;364:77-83. doi: 10.1016/j.jns.2016.03.011. Epub 2016 Mar 5. PubMed 27084221 ↗
  • Panara V, Navarra R, Mattei PA, Piccirilli E, Bartoletti V, Uncini A, Caulo M. Correlations between cervical spinal cord magnetic resonance diffusion tensor and diffusion kurtosis imaging metrics and motor performance in patients with chronic ischemic brain lesions of the corticospinal tract. Neuroradiology. 2019 Feb;61(2):175-182. doi: 10.1007/s00234-018-2139-5. Epub 2018 Dec 5. PubMed 30519889 ↗

Individual participant data

Plan to share: No

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Sep 1, 2026, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT06935578
Lead sponsor
Fondazione I.R.C.C.S. Istituto Neurologico Carlo Besta
Responsible party
Sponsor
First posted
Apr 20, 2025
Start date
May 1, 2023
Primary completion
May 19, 2026
Completion
May 19, 2026
Last update
Sep 1, 2026

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Aug 2026. You cannot join it, but the record below documents what was studied.

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