ABSTRACT
Background and aims: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with ischemic stroke (IS). We aimed to evaluate the safety and disability outcomes of revascularization treatments in patients with IS and COVID-19. Methods: Retrospective multicenter cohort study of consecutive IS patients receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March-2020 and June-2021, tested for SARSCoV- 2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). Study protocol was registered in ClinicalTrials.gov (NCT04895462). Results: Among 15128 revascularized patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT only, and 9280 (61.3%) EVT (+/- IVT). As shown in the Figure, treated patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH), symptomatic subarachnoid hemorrhage (sSAH), the combination thereof, higher mortality at 24 hours and 3 months, and worse 3-month modified Rankin score (mRS). Results for treatment subgroups were similar, except that in the IVT-only group only SICH, 3-month mRS and mortality were significantly increased. Conclusion: Ischemic stroke patients with COVID-19 showed higher rates of bleeding complications and worse clinical outcomes after acute revascularization treatments than contemporaneous non-COVID-19 treated patients. (Table Presented).