Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19
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Published:2022-11-09
Issue:7
Volume:100
Page:e739-e750
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ISSN:0028-3878
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Container-title:Neurology
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language:en
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Short-container-title:Neurology
Author:
Marto João PedroORCID, Strambo Davide, Ntaios George, Nguyen Thanh N., Herzig Roman, Czlonkowska Anna, Demeestere Jelle, Mansour Ossama Yassin, Salerno Alexander, Wegener Susanne, Baumgartner Philipp, Cereda Carlo W., Bianco Giovanni, Beyeler Morin, Arnold Marcel, Carrera Emmanuel, Machi Paolo, Altersberger Valerian, Bonati Leo, Gensicke Henrik, Bolognese Manuel, Peters Nils, Wetzel Stephan, Magriço Marta, Ramos João Nuno, Sargento-Freitas João, Machado Rita, Maia Carolina, Machado Egídio, Nunes Ana Paiva, Ferreira Patricia, Pinho e Melo Teresa, Dias Mariana Carvalho, Paula André, Correia Manuel Alberto, Castro Pedro, Azevedo Elsa, Albuquerque Luís, Alves José Nuno, Ferreira-Pinto Joana, Meira Torcato, Pereira Liliana, Rodrigues Miguel, Araujo Andre Pinho, Rodrigues Marta, Rocha Mariana, Pereira-Fonseca Ângelo, Ribeiro Luís, Varela Ricardo, Malheiro Sofia, Cappellari Manuel, Zivelonghi Cecilia, Sajeva Giulia, Zini Andrea, Gentile Mauro, Forlivesi Stefano, Migliaccio Ludovica, Sessa Maria, La Gioia Sara, 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, Maïer Benjamin, Charbonnier Guillaume, Vuillier Fabrice, Legris Loïc, Cuisenier Pauline, Vodret Francesca R., Marnat Gaultier, Liegey Jean-Sebastien, Sibon Igor, Flottmann Fabian, Broocks Gabriel, Gloyer Nils-Ole, Bohmann Ferdinand O., Schaefer Jan Hendrik, Nolte Christian, Audebert Heinrich J., Siebert Eberhard, Sykora Marek, Lang Wilfried, Ferrari Julia, Mayer-Suess Lukas, Knoflach Michael, Gizewski Elke Ruth, Stolp Jeffrey, Stolze Lotte J., Coutinho Jonathan M., Nederkoorn Paul, van den Wijngaard Ido, De Meris Joke, Lemmens Robin, De Raedt Sylvie, Vandervorst Fenne, Rutgers Matthieu Pierre, Guilmot Antoine, Dusart Anne, Bellante Flavio, Calleja-Castaño Patricia, Ostos Fernando, González-Ortega Guillermo, Martín-Jiménez Paloma, García-Madrona Sebastian, Cruz-Culebras Antonio, Vera Rocio, Matute Maria Consuelo, Fuentes Blanca, Alonso-de-Leciñana María, Rigual Ricardo, Díez-Tejedor Exuperio, Perez-Sanchez Soledad, Montaner Joan, Díaz-Otero Fernando, Pérez-de-la-Ossa Natalia, Flores-Pina Belén, Muñoz-Narbona Lucia, Chamorro Angel, Rodríguez-Vázquez Alejandro, Renú Arturo, Ayo-Martin Oscar, Hernández-Fernández 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, Šimůnek Libor, Krajíčková Dagmar, Krajina Antonín, Mikulik Robert, Cviková Martina, Vinklárek Jan, Školoudík David, Roubec Martin, Hurtikova Eva, Hrubý Rostislav, Ostry Svatopluk, Skoda Ondrej, Pernicka Marek, Jurak Lubomir, Eichlová Zuzana, Jíra Martin, Kovar Martin, Panský Michal, Mencl Pavel, Palouskova Hana, Tomek Aleš, Janský Petr, Olšerová Anna, Sramek Martin, Havlicek Roman, Malý Petr, Trakal Lukáš, Fiksa Jan, Slovák Matěj, 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 Paweł, Budrewicz Slawomir, Guziński Maciej, Świtońska Milena, Rutkowska Iwona, Sobieszak-Skura Paulina, Labuz-Roszak Beata M., Debiec Aleksander, Staszewski Jacek, Stępień Adam, Zwiernik Jacek, Wasilewski Grzegorz, Tiu Cristina, Terecoasă 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, El Naamani Kareem, Tjoumakaris Stavropoula, Abbas Rawad, Mohamed Ghada A., Chebl Alex, Min Jiangyong, Hovingh Majesta, Tsai Jenney P., Khan Muhib, Nalleballe Krishna, Onteddu Sanjeeva, Masoud Hesham, Michael Mina, Kaur Navreet, Maali Laith, Abraham Michael G., Khandelwal Priyank, Bach Ivo, Ong Melody, Babici Denis, Khawaja Ayaz M., Hakemi Maryam, Rajamani Kumar, Cano-Nigenda Vanessa, Arauz Antonio, Amaya Pablo, Llanos Natalia, Arango Akemi, Vences Miguel Ángel, Barrientos Guerra Jose Dominguo, Caetano Rayllene, Martins Rodrigo Targa, Scollo Sergio Daniel, Yalung Patrick Matic, Nagendra Shashank, Gaikwad Abhijit, Seo Kwon-Duk, Georgiopoulos Georgios, Nogueira Raul G., Michel Patrik,
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Neurology (clinical)
Cited by
13 articles.
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