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

TY - JOUR

T1 - Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19

AU - Marto, João Pedro

AU - Strambo, Davide

AU - Ntaios, George

AU - Nguyen, Thanh N.

AU - Herzig, Roman

AU - Czlonkowska, Anna

AU - Demeestere, Jelle

AU - Mansour, Ossama Yassin

AU - Salerno, Alexander

AU - Wegener, Susanne

AU - Baumgartner, Philipp

AU - Cereda, Carlo W.

AU - Bianco, Giovanni

AU - Beyeler, Morin

AU - Arnold, Marcel

AU - Carrera, Emmanuel

AU - Machi, Paolo

AU - Altersberger, Valerian

AU - Bonati, Leo

AU - Gensicke, Henrik

AU - Bolognese, Manuel

AU - Peters, Nils

AU - Wetzel, Stephan

AU - Magriço, Marta

AU - Ramos, João Nuno

AU - Sargento-Freitas, João

AU - Machado, Rita

AU - Maia, Carolina

AU - Machado, Egídio

AU - Nunes, Ana Paiva

AU - Ferreira, Patricia

AU - Pinho e Melo, Teresa

AU - Dias, Mariana Carvalho

AU - Paula, André

AU - Correia, Manuel Alberto

AU - Castro, Pedro

AU - Azevedo, Elsa

AU - Albuquerque, Luís

AU - Alves, José Nuno

AU - Ferreira-Pinto, Joana

AU - Meira, Torcato

AU - Pereira, Liliana

AU - Rodrigues, Miguel

AU - Araujo, Andre Pinho

AU - Rodrigues, Marta

AU - Rocha, Mariana

AU - Pereira-Fonseca, Ângelo

AU - Ribeiro, Luís

AU - Varela, Ricardo

AU - Malheiro, Sofia

AU - Cappellari, Manuel

AU - Zivelonghi, Cecilia

AU - Sajeva, Giulia

AU - Zini, Andrea

AU - Gentile, Mauro

AU - Forlivesi, Stefano

AU - Migliaccio, Ludovica

AU - Sessa, Maria

AU - La Gioia, Sara

AU - Pezzini, Alessandro

AU - Sangalli, Davide

AU - Zedde, Marialuisa

AU - Pascarella, Rosario

AU - Ferrarese, Carlo

AU - Beretta, Simone

AU - Diamanti, Susanna

AU - Schwarz, Ghil

AU - Frisullo, Giovanni

AU - Marcheselli, Simona

AU - Seners, Pierre

AU - Sabben, Candice

AU - Escalard, Simon

AU - Piotin, Michel

AU - Maïer, Benjamin

AU - Charbonnier, Guillaume

AU - Vuillier, Fabrice

AU - Legris, Loïc

AU - Cuisenier, Pauline

AU - Vodret, Francesca R.

AU - Marnat, Gaultier

AU - Liegey, Jean-Sebastien

AU - Sibon, Igor

AU - Flottmann, Fabian

AU - Broocks, Gabriel

AU - Gloyer, Nils-Ole

AU - Bohmann, Ferdinand O.

AU - Schaefer, Jan Hendrik

AU - Nolte, Christian

AU - Audebert, Heinrich J.

AU - Siebert, Eberhard

AU - Sykora, Marek

AU - Lang, Wilfried

AU - Ferrari, Julia

AU - Mayer-Suess, Lukas

AU - Knoflach, Michael

AU - Gizewski, Elke Ruth

AU - Stolp, Jeffrey

AU - Stolze, Lotte J.

AU - Coutinho, Jonathan M.

AU - Nederkoorn, Paul

AU - van den Wijngaard, Ido

AU - De Meris, Joke

AU - Lemmens, Robin

AU - De Raedt, Sylvie

AU - Vandervorst, Fenne

AU - Rutgers, Matthieu Pierre

AU - Guilmot, Antoine

AU - Dusart, Anne

AU - Bellante, Flavio

AU - Calleja-Castaño, Patricia

AU - Ostos, Fernando

AU - González-Ortega, Guillermo

AU - Martín-Jiménez, Paloma

AU - García-Madrona, Sebastian

AU - Cruz-Culebras, Antonio

AU - Vera, Rocio

AU - Matute, Maria Consuelo

AU - Fuentes, Blanca

AU - Alonso-de-Leciñana, María

AU - Rigual, Ricardo

AU - Díez-Tejedor, Exuperio

AU - Perez-Sanchez, Soledad

AU - Montaner, Joan

AU - Díaz-Otero, Fernando

AU - Pérez-de-la-Ossa, Natalia

AU - Flores-Pina, Belén

AU - Muñoz-Narbona, Lucia

AU - Chamorro, Angel

AU - Rodríguez-Vázquez, Alejandro

AU - Renú, Arturo

AU - Ayo-Martin, Oscar

AU - Hernández-Fernández, Francisco

AU - Segura, Tomas

AU - Tejada-Meza, Herbert

AU - Sagarra-Mur, Daniel

AU - Serrano-Ponz, Marta

AU - Hlaing, Thant

AU - See, Isaiah

AU - Simister, Robert

AU - Werring, David

AU - Kristoffersen, Espen Saxhaug

AU - Nordanstig, Annika

AU - Jood, Katarina

AU - Rentzos, Alexandros

AU - Šimůnek, Libor

AU - Krajíčková, Dagmar

AU - Krajina, Antonín

AU - Mikulik, Robert

AU - Cviková, Martina

AU - Vinklárek, Jan

AU - Školoudík, David

AU - Roubec, Martin

AU - Hurtikova, Eva

AU - Hrubý, Rostislav

AU - Ostry, Svatopluk

AU - Skoda, Ondrej

AU - Pernicka, Marek

AU - Jurak, Lubomir

AU - Eichlová, Zuzana

AU - Jíra, Martin

AU - Kovar, Martin

AU - Panský, Michal

AU - Mencl, Pavel

AU - Palouskova, Hana

AU - Tomek, Aleš

AU - Janský, Petr

AU - Olšerová, Anna

AU - Sramek, Martin

AU - Havlicek, Roman

AU - Malý, Petr

AU - Trakal, Lukáš

AU - Fiksa, Jan

AU - Slovák, Matěj

AU - Karlinski, Michal Adam

AU - Nowak, Maciej

AU - Sienkiewicz-Jarosz, Halina

AU - Bochynska, Anna

AU - Wrona, Pawel

AU - Homa, Tomasz

AU - Sawczynska, Katarzyna

AU - Slowik, Agnieszka

AU - Wlodarczyk, Ewa

AU - Wiacek, Marcin

AU - Tomaszewska-Lampart, Izabella

AU - Sieczkowski, Bartosz

AU - Bartosik-Psujek, Halina

AU - Bilik, Marta

AU - Bandzarewicz, Anna

AU - Dorobek, Malgorzata

AU - Zielinska-Turek, Justyna

AU - Nowakowska-Kotas, Marta

AU - Obara, Krystian

AU - Urbanowski, Paweł

AU - Budrewicz, Slawomir

AU - Guziński, Maciej

AU - Świtońska, Milena

AU - Rutkowska, Iwona

AU - Sobieszak-Skura, Paulina

AU - Labuz-Roszak, Beata M.

AU - Debiec, Aleksander

AU - Staszewski, Jacek

AU - Stępień, Adam

AU - Zwiernik, Jacek

AU - Wasilewski, Grzegorz

AU - Tiu, Cristina

AU - Terecoasă, Elena Oana

AU - Radu, Razvan Alexandru

AU - Negrila, Anca

AU - Dorobat, Bogdan

AU - Panea, Cristina

AU - Tiu, Vlad

AU - Petrescu, Simona

AU - Ozdemir, Atilla

AU - Mahmoud, Mostafa

AU - El-Samahy, Hussam

AU - Abdelkhalek, Hazem

AU - Al-Hashel, Jasem

AU - Ismail, Ismail Ibrahim

AU - Salmeen, Athari

AU - Ghoreishi, Abdoreza

AU - Sabetay, Sergiu Ionut

AU - Gross, Hana

AU - Klein, Piers

AU - Abdalkader, Mohamad

AU - Jabbour, Pascal

AU - El Naamani, Kareem

AU - Tjoumakaris, Stavropoula

AU - Abbas, Rawad

AU - Mohamed, Ghada A.

AU - Chebl, Alex

AU - Min, Jiangyong

AU - Hovingh, Majesta

AU - Tsai, Jenney P.

AU - Khan, Muhib

AU - Nalleballe, Krishna

AU - Onteddu, Sanjeeva

AU - Masoud, Hesham

AU - Michael, Mina

AU - Kaur, Navreet

AU - Maali, Laith

AU - Abraham, Michael G.

AU - Khandelwal, Priyank

AU - Bach, Ivo

AU - Ong, Melody

AU - Babici, Denis

AU - Khawaja, Ayaz M.

AU - Hakemi, Maryam

AU - Rajamani, Kumar

AU - Cano-Nigenda, Vanessa

AU - Arauz, Antonio

AU - Amaya, Pablo

AU - Llanos, Natalia

AU - Arango, Akemi

AU - Vences, Miguel Ángel

AU - Barrientos Guerra, Jose Dominguo

AU - Caetano, Rayllene

AU - Martins, Rodrigo Targa

AU - Scollo, Sergio Daniel

AU - Yalung, Patrick Matic

AU - Nagendra, Shashank

AU - Gaikwad, Abhijit

AU - Seo, Kwon-Duk

AU - Georgiopoulos, Georgios

AU - Nogueira, Raul G.

AU - Michel, Patrik

AU - Global COVID-19 Stroke Registry

PY - 2023/2/14

Y1 - 2023/2/14

N2 - Background and Objectives COVID-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.Methods This 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).Results Of 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).Discussion Patients 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 Information The study was registered under ClinicalTrials.gov identifier NCT04895462.ACE2=angiotensin-converting enzyme 2; AIS=acute ischemic stroke; DMT=direct mechanical thrombectomy; EVT=endovascular treatment; IQR=interquartile range; IVT=intravenous thrombolysis; mRS=modified Rankin scale; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2; SICH=symptomatic intracerebral hemorrhage; SSAH=symptomatic subarachnoid hemorrhage

AB - Background and Objectives COVID-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.Methods This 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).Results Of 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).Discussion Patients 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 Information The study was registered under ClinicalTrials.gov identifier NCT04895462.ACE2=angiotensin-converting enzyme 2; AIS=acute ischemic stroke; DMT=direct mechanical thrombectomy; EVT=endovascular treatment; IQR=interquartile range; IVT=intravenous thrombolysis; mRS=modified Rankin scale; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2; SICH=symptomatic intracerebral hemorrhage; SSAH=symptomatic subarachnoid hemorrhage

KW - Brain Ischemia/complications

KW - COVID-19/complications

KW - Cerebral Hemorrhage/complications

KW - Cohort Studies

KW - Endovascular Procedures/adverse effects

KW - Fibrinolytic Agents/therapeutic use

KW - Humans

KW - Intracranial Hemorrhages/etiology

KW - Ischemic Stroke/epidemiology

KW - Registries

KW - Stroke/epidemiology

KW - Thrombolytic Therapy/adverse effects

KW - Treatment Outcome

U2 - 10.1212/WNL.0000000000201537

DO - 10.1212/WNL.0000000000201537

M3 - SCORING: Zeitschriftenaufsatz

C2 - 36351814

VL - 100

SP - e739-e750

JO - NEUROLOGY

JF - NEUROLOGY

SN - 0028-3878

IS - 7

M1 - e739

ER -