PRONÓSTICO DE PACIENTES COVID-19 CON ICTUS ISQUÉMICO Y TRATAMIENTO NEUROINTERVENCIONISTA

Resumen Objetivo: Presentar nuestra experiencia y analizar el pronóstico de pacientes COVID-19 con ictus isquémico agudo por oclusión de grandes vasos (OGV) tratados con neurointervencionismo (NIV) en la unidad de ictus. Material y Métodos: Se incluyeron todos los pacientes consecutivos con ictus isquémico agudo debido a OGV tratados por NIV en nuestra institución entre marzo y abril-2020 durante el brote de COVID-19. Se realizó una comparación entre pacientes con COVID-19 y pacientes sin infección por coronavirus. Se comunican los resultados clínicos iniciales y a corto plazo. Resultados: Del 1 de marzo al 30 de abril, se realizaron 25 procedimientos de NIV por ictus isquémico agudo en nuestra institución. Ocho pacientes eran COVID-19 y 17 eran pacientes no COVID-19. La edad media de los pacientes con COVID-19 fue de 70,1 ± 12,23 años, y 7 fueron hombres (87,5%, p = 0,006). Mientras que todos los pacientes sin COVID procedían de emergencias, sólo 5 pacientes con COVID-19 (62.5%) fueron atendidos desde urgencias por ictus (p = 0,01). Tres pacientes procedían de hospitalización. La tasa de mortalidad en pacientes sin COVID-19 fue del 5,8%, pero en pacientes con COVID-19 fue considerablemente alta (50%). Ningún parámetro analítico difirió entre ambos grupos. No se registraron hemorragias en esta serie. En comparación con el mismo período del año pasado, se observó una disminución de la actividad neurointervencionista del 39%. Conclusiones: La mejor terapia médica y de NIV, resultó en malos resultados y una mortalidad dramática. La pandemia de COVID-19 dificultó significativamente el funcionamiento normal de los servicios de emergencias y la atención de estos pacientes con ictus. Purpose: We report our experience and analyse the prognosis of acute ischaemic stroke due to large vessel occlusion (LVO) in patients with COVID-19 receiving neurointerventional treatment. Material and methods: The study included all consecutive patients with acute ischaemic stroke due to LVO treated with neurointerventional techniques at our institution in March and April 2020, during the COVID-19 outbreak, and compared patients with and without COVID-19. Baseline and short-term clinical data were reported. Results: From 1 March to 30 April 2020, 25 neurointerventional procedures were performed to treat acute ischaemic stroke due to LVO at our institution. Eight patients had COVID-19 and 17 did not. The mean age (SD) of patients with COVID-19 was 70.1 (12.23) years, and 7 were men (87.5%, P = .006). While all 17 patients without COVID-19 were referred from the emergency department, only 5 (62.5%) COVID-19 patients were treated for stroke at the emergency department (P = .01). Three patients had to be hospitalised. The mortality rate was considerably higher among patients with COVID-19 (50%, vs 5.5% in patients without COVID-19). Both groups presented similar laboratory parameters. No haemorrhages were recorded in this series. We observed a 39% decrease in neurointerventional procedures in comparison with the same period the previous year. Conclusions: The best medical and neurointerventional treatment resulted in poor outcomes and a dramatic mortality rate. The COVID-19 pandemic significantly disrupted the normal functioning of stroke management in emergency departments.

Mortality of COVID-19 patients with vascular thrombotic complications.

PURPOSE: To analyze the survival of patients hospitalized with COVID-19 and who presented some vascular thrombotic complication. MATERIAL AND METHODS: All consecutive patients with COVID-19 who were treated during the months of March and April 2020 at our institution were included. All patients were symptomatic and the thrombotic event objectively confirmed. Patients with deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and peripheral arterial thrombosis (PAT) were included. Survival curves for all groups were analyzed using Kaplan-Meier with Log Rank test, and Cox regression. RESULTS: During the pandemic period from March-1 to April-30, 2943 patients were treated with confirmed COVID-19 in our center. 106 patients showed some symptomatic vascular thrombosis: 13 patients had PAT, 15 ischemic stroke, 20 DVT and 58 PE. 11 patients presented multiple vascular thrombosis. Although the mean age was 65 years, there were differences between groups being older those patients with arterial thrombosis. A 67.92% were men. In total, 25 patients died during their hospital admission (23.58%), with differences between groups, being more common in patients with PAT (9 patients out of 13) and ischemic stroke (8 patients out of 15), than in those with DVT (1 patient out of 20) or PE (7 patients out of 58). CONCLUSIONS: The venous thromboembolic risk in these patients is greater than the arterial, but arterial thrombosis when it occurs was associated with high mortality rates. Survival was better in patients with DVT and PE than in patients with ischemic stroke or PAT.

OBJETIVO: Presentar nuestra experiencia y analizar la supervivencia de los pacientes hospitalizados con COVID-19 y que presentaron algún proceso trombótico vascular. MATERIAL Y MÉTODOS: Se incluyeron todos los pacientes consecutivos COVID-19 que fueron atendidos durante los meses de marzo-abril 2020 en nuestra institución. Se incluyeron pacientes sintomáticos con trombosis venosa profunda (TVP), tromboembolia pulmonar (TEP), ictus isquémico y trombosis arterial periférica (TAP) confirmados objetivamente. Se analizaron las curvas de supervivencia de todos los grupos mediante Kaplan-Meier, test de Log Rank, y regresión de Cox. RESULTADOS: Durante el periodo pandémico del 1-marzo al 30-abril, se atendieron 2943 pacientes COVID-19 en nuestro centro. 106 pacientes presentaron algún proceso trombótico vascular sintomático: 13 pacientes tuvieron TAP, 15 ictus, 20 TVP y 58 TEP. 11 pacientes mostraron trombosis vasculares múltiples. Aunque la edad media fue de 65 años, fueron de edad más avanzada los que mostraron trombosis arteriales que procesos tromboembólicos venosos. El 67.92% fueron hombres. En total, 25 pacientes murieron durante su ingreso hospitalario (23.58%), existiendo diferencias entre grupos siendo más común en pacientes con TAP (9 pacientes de 13), e ictus isquémico (8 pacientes de 15), que en los de TVP (1 paciente de 20) o TEP (7 pacientes de 58). CONCLUSIONES: El riesgo tromboembólico venoso en estos pacientes es mayor que el arterial, pero la trombosis arterial cuando acontece estuvo asociada a altas tasas de mortalidad. La supervivencia fue mejor en los pacientes con TVP y TEP que en los pacientes con ictus isquémico o trombosis arterial periférica.

[Mortality of covid-19 patients with vascular thrombotic complications]. / Mortalidad de los pacientes covid-19 con complicaciones trombóticas.

OBJECTIVE: To analyze the survival of patients hospitalized with covid-19 and who presented some vascular thrombotic complication. MATERIAL AND METHODS: All consecutive patients with covid-19 who were treated during the months of March and April 2020 at our institution were included. All patients were symptomatic and the thrombotic event objectively confirmed. Patients with deep vein thrombosis (DVT), pulmonary embolism (PE), ischemic stroke, and peripheral arterial thrombosis (PAT) were included. Survival curves for all groups were analyzed using Kaplan-Meier with log rank test, and Cox regression. RESULTS: During the pandemic period from March-1 to April-30, 2943 patients were treated with confirmed covid-19 in our center. Of them, 106 patients showed some symptomatic vascular thrombosis: 13 patients had PAT, 15 ischemic stroke, 20 DVT and 58 PE. Another 11 patients presented multiple vascular thrombosis. Although the mean age was 65 years, there were differences between groups being older those patients with arterial thrombosis. A 67.92% were men. In total, 25 patients died during their hospital admission (23.58%), with differences between groups, being more common in patients with PAT (9 patients out of 13) and ischemic stroke (8 patients out of 15), than in those with DVT (1 patient out of 20) or PE (7 patients out of 58). CONCLUSIONS: The venous thromboembolic risk in these patients is greater than the arterial, but arterial thrombosis when it occurs was associated with high mortality rates. Survival was better in patients with DVT and PE than in patients with ischemic stroke or PAT.

COVID-19-Related Aortic Thrombosis: A Report of Four Cases.

COVID-19 may predispose patients to an increased risk of thrombotic complications through various pathophysiological mechanisms. Most of the reports on a high incidence of thrombotic complications are in relation to deep vein thrombosis and pulmonary embolism, while the evidence about arterial thrombosis in patients with COVID-19 is limited. We describe 4 cases of aortic thrombosis and associated ischemic complications in patients with severe SARS-CoV-2 infection.