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November 09, 2022Research Article

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

João Pedro Marto, Davide Strambo, George Ntaios, Thanh N. Nguyen, Roman Herzig, Anna Czlonkowska, Jelle Demeestere, Ossama Yassin Mansour, Alexander Salerno, Susanne Wegener, Philipp Baumgartner, Carlo W Cereda, Giovanni Bianco, Morin Beyeler, Marcel Arnold, Emmanuel Carrera, Paolo Machi, Valerian Altersberger, Leo Bonati, Henrik Gensicke, Manuel Bolognese, Nils Peters, Stephan Wetzel, Marta Magriço, João Nuno Ramos, João Sargento-Freitas, Rita Machado, Carolina Maia, Egídio Machado, Ana Paiva Nunes, Patricia Ferreira, Teresa Pinho e Melo, Mariana Carvalho Dias, André Paula, Manuel Alberto Correia, Pedro Castro, Elsa Azevedo, Luís Albuquerque, José Nuno Alves, Joana Ferreira-Pinto, Torcato Meira, Liliana Pereira, Miguel Rodrigues, Andre Pinho Araujo, Marta Rodrigues, Mariana Rocha, Ângelo Pereira-Fonseca, Luís Ribeiro, Ricardo Varela, Sofia Malheiro, Manuel Cappellari, Cecilia Zivelonghi, Giulia Sajeva, Andrea Zini, mauro gentile, Stefano Forlivesi, Ludovica Migliaccio, Maria Sessa, Sara La Gioia, Alessandro Pezzini, Davide Sangalli, Marialuisa Zedde, Rosario Pascarella, Carlo Ferrarese, Simone Beretta, Susanna Diamanti, Ghil Schwarz, Giovanni Frisullo, Simona Marcheselli, Pierre Seners, Candice Sabben, Simon Escalard, Michel Piotin, Benjamin Maïer, Guillaume Charbonnier, Fabrice Vuillier, Loïc Legris, Pauline Cuisenier, Francesca R Vodret, Gaultier Marnat, Jean-Sebastien Liegey, Igor Sibon, Fabian Flottmann, Gabriel Broocks, Nils-Ole Gloyer, Ferdinand O. Bohmann, Jan Hendrik Schaefer, Christian Nolte, Heinrich J. Audebert, Eberhard Siebert, Marek Sykora, Wilfried Lang, Julia Ferrari, Lukas Mayer-Suess, Michael Knoflach, Elke Ruth Gizewski, Jeffrey Stolp, Lotte J Stolze, Jonathan M. Coutinho, Paul Nederkoorn, Ido van den Wijngaard, Joke De Meris, Robin Lemmens, Sylvie De Raedt, Fenne Vandervorst, Matthieu Pierre Rutgers, Antoine Guilmot, Anne Dusart, Flavio Bellante, Patricia Calleja-Castaño, Fernando Ostos, Guillermo González-Ortega, Paloma Martín-Jiménez, Sebastian García-Madrona, Antonio Cruz-Culebras, Rocio Vera, Maria Consuelo Matute, Blanca Fuentes, María Alonso-de-Leciñana, Ricardo Rigual, Exuperio Díez-Tejedor, Soledad Perez-Sanchez, Joan Montaner, Fernando Díaz-Otero, Natalia Pérez-de-la-Ossa, Belén Flores-Pina, Lucia Muñoz-Narbona, Angel Chamorro, Alejandro Rodríguez-Vázquez, Arturo Renú, Oscar Ayo-Martin, Francisco Hernández-Fernández, Tomas Segura, Herbert Tejada-Meza, Daniel Sagarra-Mur, Marta Serrano-Ponz, Thant Hlaing, Isaiah See, Robert Simister, David Werring, Espen Saxhaug Kristoffersen, Annika Nordanstig, Katarina Jood, Alexandros Rentzos, Libor Šimůnek, Dagmar Krajíčková, Antonín Krajina, Robert Mikulik, Martina Cviková, Jan Vinklárek, David Školoudík, Martin Roubec, Eva Hurtikova, Rostislav Hrubý, Svatopluk Ostry, Ondrej Skoda, Marek Pernicka, Lubomir Jurak, Zuzana Eichlová, Martin Jíra, Martin Kovar, Michal Panský, Pavel Mencl, Hana Palouskova, Aleš Tomek, Petr Janský, Anna Olšerová, Martin Sramek, Roman Havlicek, Petr Malý, Lukáš Trakal, Jan Fiksa, Matěj Slovák, Michal Adam Karlinski, Maciej Nowak, Halina Sienkiewicz-Jarosz, Anna Bochynska, Pawel Wrona, Tomasz Homa, Katarzyna Sawczynska, Agnieszka Slowik, Ewa Wlodarczyk, Marcin Wiacek, Izabella Tomaszewska-Lampart, Bartosz Sieczkowski, Halina Bartosik-Psujek, Marta Bilik, Anna Bandzarewicz, Malgorzata Dorobek, Justyna Zielinska-Turek, Marta Nowakowska-Kotas, Krystian Obara, Paweł Urbanowski, Slawomir Budrewicz, Maciej Guziński, Milena Świtońska, Iwona Rutkowska, Paulina Sobieszak-Skura, Beata M. Labuz-Roszak, Aleksander Debiec, Jacek Staszewski, Adam Stępień, Jacek Zwiernik, Grzegorz Wasilewski, Cristina Tiu, Elena Oana Terecoasă, Razvan Alexandru Radu, Anca Negrila, Bogdan Dorobat, Cristina Panea, Vlad Tiu, Simona Petrescu, Atilla Ozdemir, Mostafa Mahmoud, Hussam El-Samahy, Hazem Abdelkhalek, Jasem Al-Hashel, Ismail Ibrahim Ismail, Athari Salmeen, Abdoreza Ghoreishi, Sergiu Ionut Sabetay, Hana Gross, Piers Klein, Mohamad Abdalkader, Pascal Jabbour, Kareem El Naamani, Stavropoula Tjoumakaris, Rawad Abbas, Ghada A. Mohamed, Alex Chebl, Jiangyong Min, Majesta Hovingh, Jenney P Tsai, Muhib Khan, Krishna Nalleballe, Sanjeeva Onteddu, Hesham Masoud, Mina Michael, Navreet Kaur, Laith Maali, Michael G Abraham, Priyank Khandelwal, Ivo Bach, Melody Ong, Denis Babici, Ayaz M. Khawaja, Maryam Hakemi, Kumar Rajamani, Vanessa Cano-Nigenda, Antonio Arauz, Pablo Amaya, Natalia Llanos, Akemi Arango, Miguel Ángel Vences, Jose Dominguo Barrientos Guerra, Rayllene Caetano, Rodrigo Targa Martins, Sergio Daniel Scollo, Patrick Matic Yalung, Shashank Nagendra, Abhijit Gaikwad, Kwon-Duk Seo, Georgios Georgiopoulos, Raul G Nogueira, Patrik Michel, on behalf of and the Global COVID-19 Stroke Registry
First published November 9, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201537
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Abstract

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.

  • Received April 27, 2022.
  • Accepted in final form September 23, 2022.

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