6533b7d3fe1ef96bd1260b8c

RESEARCH PRODUCT

Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.

João Pedro MartoDavide StramboGeorge NtaiosThanh N NguyenRoman HerzigAnna CzlonkowskaJelle DemeestereOssama Yassin MansourAlexander SalernoSusanne WegenerPhilipp BaumgartnerCarlo W CeredaGiovanni BiancoMorin BeyelerMarcel ArnoldEmmanuel CarreraPaolo MachiValerian AltersbergerLeo BonatiHenrik GensickeManuel BologneseNils PetersStephan WetzelMarta MagriçoJoão Nuno RamosJoão Sargento-freitasRita MachadoCarolina MaiaEgídio MachadoAna Paiva NunesPatricia FerreiraTeresa Pinho E MeloMariana Carvalho DiasAndré PaulaManuel Alberto CorreiaPedro CastroElsa AzevedoLuís AlbuquerqueJosé Nuno AlvesJoana Ferreira-pintoTorcato MeiraLiliana PereiraMiguel RodriguesAndre Pinho AraujoMarta RodriguesMariana RochaÂNgelo Pereira-fonsecaLuís RibeiroRicardo VarelaSofia MalheiroManuel CappellariCecilia ZivelonghiGiulia SajevaAndrea ZiniMauro GentileStefano ForlivesiLudovica MigliaccioMaria SessaSara La GioiaAlessandro PezziniDavide SangalliMarialuisa ZeddeRosario PascarellaCarlo FerrareseSimone BerettaSusanna DiamantiGhil SchwarzGiovanni FrisulloSimona MarcheselliPierre SenersCandice SabbenSimon EscalardMichel PiotinBenjamin MaïerGuillaume CharbonnierFabrice VuillierLoïc LegrisPauline CuisenierFrancesca R VodretGaultier MarnatJean-sebastien LiegeyIgor SibonFabian FlottmannGabriel BroocksNils-ole GloyerFerdinand O BohmannJan Hendrik SchaeferChristian NolteHeinrich J AudebertEberhard SiebertMarek SykoraWilfried LangJulia FerrariLukas Mayer-suessMichael KnoflachElke Ruth GizewskiJeffrey StolpLotte J StolzeJonathan M CoutinhoPaul NederkoornIdo Van Den WijngaardJoke De MerisRobin LemmensSylvie De RaedtFenne VandervorstMatthieu Pierre RutgersAntoine GuilmotAnne DusartFlavio BellantePatricia Calleja-castañoFernando OstosGuillermo González-ortegaPaloma Martín-jiménezSebastian García-madronaAntonio Cruz-culebrasRocio VeraMaria Consuelo MatuteBlanca FuentesMaría Alonso-de-leciñanaRicardo RigualExuperio Díez-tejedorSoledad Perez-sanchezJoan MontanerFernando Díaz-oteroNatalia Pérez-de-la-ossaBelén Flores-pinaLucia Muñoz-narbonaAngel ChamorroAlejandro Rodríguez-vázquezArturo RenúOscar Ayo-martinFrancisco Hernández-fernándezTomas SeguraHerbert Tejada-mezaDaniel Sagarra-murMarta Serrano-ponzThant HlaingIsaiah SeeRobert SimisterDavid WerringEspen Saxhaug KristoffersenAnnika NordanstigKatarina JoodAlexandros RentzosLibor ŠImůnekDagmar KrajíčkováAntonín KrajinaRobert MikulikMartina CvikováJan VinklárekDavid ŠKoloudíkMartin RoubecEva HurtikovaRostislav HrubýSvatopluk OstryOndrej SkodaMarek PernickaLubomir JurakZuzana EichlováMartin JíraMartin KovarMichal PanskýPavel MenclHana PalouskovaAleš TomekPetr JanskýAnna OlšerováMartin SramekRoman HavlicekPetr MalýLukáš TrakalJan FiksaMatěj SlovákMichal Adam KarlinskiMaciej NowakHalina Sienkiewicz-jaroszAnna BochynskaPawel WronaTomasz HomaKatarzyna SawczynskaAgnieszka SlowikEwa WlodarczykMarcin WiacekIzabella Tomaszewska-lampartBartosz SieczkowskiHalina Bartosik-psujekMarta BilikAnna BandzarewiczMalgorzata DorobekJustyna Zielinska-turekMarta Nowakowska-kotasKrystian ObaraPaweł UrbanowskiSlawomir BudrewiczMaciej GuzińskiMilena ŚWitońskaIwona RutkowskaPaulina Sobieszak-skuraBeata M Labuz-roszakAleksander DebiecJacek StaszewskiAdam StępieńJacek ZwiernikGrzegorz WasilewskiCristina TiuElena Oana TerecoasăRazvan Alexandru RaduAnca NegrilaBogdan DorobatCristina PaneaVlad TiuSimona PetrescuAtilla OzdemirMostafa MahmoudHussam El-samahyHazem AbdelkhalekJasem Al-hashelIsmail Ibrahim IsmailAthari SalmeenAbdoreza GhoreishiSergiu Ionut SabetayHana GrossPiers KleinMohamad AbdalkaderPascal JabbourKareem El NaamaniStavropoula TjoumakarisRawad AbbasGhada A MohamedAlex CheblJiangyong MinMajesta HovinghJenney P TsaiMuhib KhanKrishna NalleballeSanjeeva OntedduHesham MasoudMina MichaelNavreet KaurLaith MaaliMichael G AbrahamPriyank KhandelwalIvo BachMelody OngDenis BabiciAyaz M KhawajaMaryam HakemiKumar RajamaniVanessa Cano-nigendaAntonio ArauzPablo AmayaNatalia LlanosAkemi ArangoMiguel ÁNgel VencesJose Dominguo Barrientos GuerraRayllene CaetanoRodrigo Targa MartinsSergio Daniel ScolloPatrick Matic YalungShashank NagendraAbhijit GaikwadKwon-duk SeoGeorgios GeorgiopoulosRaul G NogueiraPatrik Michel

subject

Fibrinolytic Agents/therapeutic useCerebral Hemorrhage/complicationsStroke/epidemiologyBrain Ischemia/complicationsTreatment OutcomeIschemic Stroke/epidemiologyCOVID-19/complicationsHumansCohort studiesEndovascular Procedures/adverse effectsRegistriesNeurology (clinical)610 Medicine & healthIntracranial Hemorrhages/etiologyThrombolytic Therapy/adverse effectsResearch Article

description

Background and ObjectivesCOVID-19–related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19.MethodsThis was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT).ResultsOf a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16–2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20–2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23–1.99), 24-hour mortality (OR 2.47; 95% CI 1.58–3.86), and 3-month mortality (OR 1.88; 95% CI 1.52–2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26–1.60).DiscussionPatients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non–COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis.Trial Registration InformationThe study was registered under ClinicalTrials.gov identifierNCT04895462.

yearjournalcountryeditionlanguage
2023-02-14
https://dx.doi.org/10.48350/174729