Marto, João Pedro; 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; ... (2023). Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry. Neurology, 100(7), e739-e750. American Academy of Neurology 10.1212/WNL.0000000000201537
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BACKGROUND AND OBJECTIVES
COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19.
METHODS
Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-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 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [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 (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients 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 acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, 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.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
UniBE Contributor: |
Beyeler, Morin, Arnold, Marcel |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1526-632X |
Publisher: |
American Academy of Neurology |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
16 Nov 2022 07:52 |
Last Modified: |
11 Nov 2023 00:25 |
Publisher DOI: |
10.1212/WNL.0000000000201537 |
PubMed ID: |
36351814 |
BORIS DOI: |
10.48350/174729 |
URI: |
https://boris.unibe.ch/id/eprint/174729 |
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