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

• Authors: MARTO Joao Pedro; STRAMBO Davide N; NTAIOS George; NGUYEN Thanh; HERZIG Roman; CZLONKOWSKA Anna; DEMEESTERE Jelle; MANSOUR Ossama Yassin; SALERNO Alexander; WEGENER Susanne W; BAUMGARTNER Philipp; CEREDA Carlo; BIANCO Giovanni; BEYELER Morin; ARNOLD Marcel; CARRERA Emmanuel; MACHI Paolo; ALTERSBERGER Valerian; BONATI Leo; GENSICKE Henrik; BOLOGNESE Manuel; PETERS Nils; WETZEL Stephan; MAGRICO Marta; RAMOS Joao Nuno; SARGENTO-FREITAS Joao; MACHADO Rita; MAIA Carolina; MACHADO Egidio; NUNES Ana Paiva; FERREIRA Patricia; TERESA Pinho e Melo; DIAS Mariana Carvalho; PAULA Andre; CORREIA Manuel Alberto; CASTRO Pedro; AZEVEDO Elsa; ALBUQUERQUE Luis; ALVES Jose Nuno; FERREIRA-PINTO Joana; MEIRA Torcato; PEREIRA Liliana; RODRIGUES Miguel; ARAUJO Andre Pinho; RODRIGUES Marta; ROCHA Mariana; PEREIRA-FONSECA Angelo; RIBEIRO Luis; VARELA Ricardo; MALHEIRO Sofia; CAPPELLARI Manuel; ZIVELONGHI Cecilia; SAJEVA Giulia; ZINI Andrea; GENTILE Mauro; FORLIVESI Stefano; MIGLIACCIO Ludovica; SESSA Maria; SARA La Gioia; PEZZINI Alessandro; SANGALLI Davide; ZEDDE Marialuisa; PASCARELLA Rosario; FERRARESE Carlo; BERETTA Simone; DIAMANTI Susanna; SCHWARZ Ghil; FRISULLO Giovanni; MARCHESELLI Simona; SENERS Pierre; SABBEN Candice; ESCALARD Simon; PIOTIN Michel; MAIER Benjamin; CHARBONNIER Guillaume; VUILLIER Fabrice; LEGRIS Loic R; CUISENIER Pauline; VODRET Francesca; MARNAT Gaultier; LIEGEY Jean-Sebastien; SIBON Igor; FLOTTMANN Fabian; BROOCKS Gabriel O; GLOYER Nils-Ole; BOHMANN Ferdinand; SCHAEFER Jan Hendrik J; NOLTE Christian; AUDEBERT Heinrich; SIEBERT Eberhard; SYKORA Marek; LANG Wilfried; FERRARI Julia; MAYER-SUESS Lukas; KNOFLACH Michael; GIZEWSKI Elke Ruth J; STOLP Jeffrey M; STOLZE Lotte; COUTINHO Jonathan; NEDERKOORN Paul; IDO van den Wijngaard; JOKE De Meris; LEMMENS Robin; SYLVIE De Raedt; VANDERVORST Fenne; RUTGERS Matthieu Pierre; GUILMOT Antoine; DUSART Anne; BELLANTE Flavio; CALLEJA-CASTANO Patricia; OSTOS Fernando; GONZALEZ-ORTEGA Guillermo; MARTIN-JIMENEZ Paloma; GARCIA-MADRONA Sebastian; CRUZ-CULEBRAS Antonio; VERA Rocio; MATUTE Maria Consuelo; FUENTES Blanca; ALONSO-DE-LECINANA Maria; RIGUAL Ricardo; DIEZ-TEJEDOR Exuperio; PEREZ-SANCHEZ Soledad; MONTANER Joan; DIAZ-OTERO Fernando; PEREZ-DE-LA-OSSA Natalia; FLORES-PINA Belen; MUNOZ-NARBONA Lucia; CHAMORRO Angel; RODRIGUEZ-VAZQUEZ Alejandro; RENU Arturo; AYO-MARTIN Oscar; HERNANDEZ-FERNANDEZ Francisco; SEGURA Tomas; TEJADA-MEZA Herbert; SAGARRA-MUR Daniel; SERRANO-PONZ Marta; HLAING Thant; SEE Isaiah; SIMISTER Robert; WERRING David; KRISTOFFERSEN Espen Saxhaug; NORDANSTIG Annika; JOOD Katarina; RENTZOS Alexandros; SIMUNEK Libor; KRAJICKOVA Dagmar; KRAJINA Antonín; MIKULÍK Robert; CVIKOVÁ Martina; VINKLÁREK Jan; SKOLOUDIK David; ROUBEC Martin; HURTIKOVA Eva; HRUBY Rostislav; OSTRY Svatopluk; SKODA Ondrej; PERNICKA Marek; JURAK Lubomir; EICHLOVA Zuzana; JIRA Martin; KOVAR Martin; PANSKY Michal; MENCL Pavel; PALOUSKOVA Hana; TOMEK Ales; JANSKY Petr; OLSEROVA Anna; SRAMEK Martin; HAVLICEK Roman; MALY Petr; TRAKAL Lukas; FIKSA Jan; SLOVAK Matej; KARLINSKI Michal Adam; NOWAK Maciej; SIENKIEWICZ-JAROSZ Halina; BOCHYNSKA Anna; WRONA Pawel; HOMA Tomasz; SAWCZYNSKA Katarzyna; SLOWIK Agnieszka; WLODARCZYK Ewa; WIACEK Marcin; TOMASZEWSKA-LAMPART Izabella; SIECZKOWSKI Bartosz; BARTOSIK-PSUJEK Halina; BILIK Marta; BANDZAREWICZ Anna; DOROBEK Malgorzata; ZIELINSKA-TUREK Justyna; NOWAKOWSKA-KOTAS Marta; OBARA Krystian; URBANOWSKI Pawel; BUDREWICZ Slawomir; GUZINSKI Maciej; SWITONSKA Milena; RUTKOWSKA Iwona; SOBIESZAK-SKURA Paulina M; LABUZ-ROSZAK Beata; DEBIEC Aleksander; STASZEWSKI Jacek; STEPIEN Adam; ZWIERNIK Jacek; WASILEWSKI Grzegorz; TIU Cristina; TERECOASA Elena Oana; RADU Razvan Alexandru; NEGRILA Anca; DOROBAT Bogdan; PANEA Cristina; TIU Vlad; PETRESCU Simona; OZDEMIR Atilla; MAHMOUD Mostafa; EL-SAMAHY Hussam; ABDELKHALEK Hazem; AL-HASHEL Jasem; ISMAIL Ismail Ibrahim; SALMEEN Athari; GHOREISHI Abdoreza; SABETAY Sergiu Ionut; GROSS Hana; KLEIN Piers; ABDALKADER Mohamad; JABBOUR Pascal; KAREEM El Naamani; TJOUMAKARIS Stavropoula; ABBAS Rawad A; MOHAMED Ghada; CHEBL Alex; MIN Jiangyong; HOVINGH Majesta P; TSAI Jenney; KHAN Muhib; NALLEBALLE Krishna; ONTEDDU Sanjeeva; MASOUD Hesham; MINA Michael; KAUR Navreet; MAALI Laith G; ABRAHAM Michael; KHANDELWAL Priyank; BACH Ivo; ONG Melody; BABICI Denis M; KHAWAJA Ayaz; HAKEMI Maryam; RAJAMANI Kumar; CANO-NIGENDA Vanessa; ARAUZ Antonio; AMAYA Pablo; LLANOS Natalia; ARANGO Akemi; VENCES Miguel Angel; DOMINGUO Barrientos Guerra Jose; CAETANO Rayllene; MARTINS Rodrigo Targa; SCOLLO Sergio Daniel; YALUNG Patrick Matic; NAGENDRA Shashank; GAIKWAD Abhijit; SEO Kwon-Duk; GEORGIOPOULOS Georgios G; NOGUEIRA Raul; MICHEL Patrik
• Year of publication: 2023
• Type: Article in Periodical
• Magazine / Source: Neurology
• MU Faculty or unit: Faculty of Medicine
• Web: https://www.neurology.org/doi/10.1212/wnl.0000000000201537
• Doi: http://dx.doi.org/10.1212/WNL.0000000000201537
• Keywords: THROMBECTOMY; COVID19; endovascular treatment; STROKE
• 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.