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SAFETY AND OUTCOME OF REVASCULARIZATION TREATMENTS IN PATIENTS WITH ACUTE ISCHEMIC STROKE AND COVID-19: RESULTS OF THE GLOBAL COVID-19 STROKE REGISTRY

Marto, J. P.; Strambo, D.; Ntaios, G.; Nguyen, T. N.; Herzig, R.; Członkowksa, A.; Demeestere, J.; Mansour, O. Y.; Georgiopoulos, G.; Nogueira, R.; Michel, P..

European Stroke Journal ; 7(1 SUPPL):102, 2022.

Article in English | EMBASE | ID: covidwho-1928106

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).

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Nguyen, T.; Qureshi, M.; Martins, S.; Yamagami, H.; Qiu, Z.; Mansour, O.; Czlonkowska, A.; Abdalkader, M.; Sathya, A.; de Sousa, D. A.; Demeestere, J.; Mikulik, R.; Vanacker, P.; Siegler, J.; Korv, J.; Biller, J.; Liang, C.; Sangha, N.; Zha, A.; Czap, A.; Holmstedt, C.; Turan, T.; Grant, C.; Ntaios, G.; Malhotra, K.; Tayal, A.; Loochtan, A.; Mistry, E.; Alexandrov, A.; Huang, D.; Yaghi, S.; Raz, E.; Sheth, S.; Frankel, M.; Lamou, E. G. B.; Aref, H.; Elbassiouny, A.; Hassan, F.; Mustafa, W.; Menecie, T.; Shokri, H.; Roushdy, T.; Sarfo, F. S.; Alabi, T.; Arabambi, B.; Nwazor, E.; Sunmonu, T. A.; Wahab, K. W.; Mohammed, H. H.; Adebayo, P. B.; Riahi, A.; Ben Sassi, S.; Gwaunza, L.; Rahman, A.; Ai, Z. B.; Bai, F. H.; Duan, Z. H.; Hao, Y. G.; Huang, W. G.; Li, G. W.; Li, W.; Liu, G. Z.; Luo, J.; Shang, X. J.; Sui, Y.; Tian, L.; Wen, H. B.; Wu, B.; Yan, Y. Y.; Yuan, Z. Z.; Zhang, H.; Zhang, J.; Zhao, W. L.; Zi, W. J.; Leung, T. K.; Sahakyan, D.; Chugh, C.; Huded, V.; Menon, B.; Pandian, J.; Sylaja, P. N.; Usman, F. S.; Farhoudi, M.; Sadeghi-Hokmabadi, E.; Reznik, A.; Sivan-Hoffman, R.; Horev, A.; Ohara, N.; Sakai, N.; Watanabe, D.; Yamamoto, R.; Doijiri, R.; Tokuda, N.; Yamada, T.; Terasaki, T.; Yazawa, Y.; Uwatoko, T.; Dembo, T.; Shimizu, H.; Sugiura, Y.; Miyashita, F.; Fukuda, H.; Miyake, K.; Shimbo, J.; Sugimura, Y.; Yagita, Y.; Takenobu, Y.; Matsumaru, Y.; Yamada, S.; Kono, R.; Kanamaru, T.; Yamazaki, H.; Sakaguchi, M.; Todo, K.; Yamamoto, N.; Sonodda, K.; Yoshida, T.; Hashimoto, H.; Nakahara, I.; Faizullina, K.; Kamenova, S.; Kondybayeva, A.; Zhanuzakov, M.; Baek, J. H.; Hwang, Y.; Lee, S. B.; Moon, J.; Park, H.; Seo, J. H.; Seo, K. D.; Young, C. J.; Ahdab, R.; Aziz, Z. A.; Zaidi, W. A. W.; Bin Basri, H.; Chung, L. W.; Husin, M.; Ibrahim, A. B.; Ibrahim, K. A.; Looi, I.; Tan, W. Y.; Yahya, Wnnw, Groppa, S.; Leahu, P.; Al Hashmi, A.; Imam, Y. Z.; Akhtar, N.; Oliver, C.; Kandyba, D.; Alhazzani, A.; Al-Jehani, H.; Tham, C. H.; Mamauag, M. J.; Narayanaswamy, R.; Chen, C. H.; Tang, S. C.; Churojana, A.; Aykac, O.; Ozdemir, A. O.; Hussain, S. I.; John, S.; Vu, H. L.; Tran, A. D.; Nguyen, H. H.; Thong, P. N.; Nguyen, T.; Nguyen, T.; Gattringer, T.; Enzinger, C.; Killer-Oberpfalzer, M.; Bellante, F.; De Blauwe, S.; Van Hooren, G.; De Raedt, S.; Dusart, A.; Ligot, N.; Rutgers, M.; Yperzeele, L.; Alexiev, F.; Sakelarova, T.; Bedekovic, M. R.; Budincevic, H.; Cindric, I.; Hucika, Z.; Ozretic, D.; Saric, M. S.; Pfeifer, F.; Karpowicz, I.; Cernik, D.; Sramek, M.; Skoda, M.; Hlavacova, H.; Klecka, L.; Koutny, M.; Vaclavik, D.; Skoda, O.; Fiksa, J.; Hanelova, K.; Nevsimalova, M.; Rezek, R.; Prochazka, P.; Krejstova, G.; Neumann, J.; Vachova, M.; Brzezanski, H.; Hlinovsky, D.; Tenora, D.; Jura, R.; Jurak, L.; Novak, J.; Novak, A.; Topinka, Z.; Fibrich, P.; Sobolova, H.; Volny, O.; Christensen, H. K.; Drenck, N.; Iversen, H.; Simonsen, C.; Truelsen, T.; Wienecke, T.; Vibo, R.; Gross-Paju, K.; Toomsoo, T.; Antsov, K.; Caparros, F.; Cordonnier, C.; Dan, M.; Faucheux, J. M.; Mechtouff, L.; Eker, O.; Lesaine, E.; Ondze, B.; Pico, F.; Pop, R.; Rouanet, F.; Gubeladze, T.; Khinikadze, M.; Lobjanidze, N.; Tsiskaridze, A.; Nagel, S.; Ringleb, P. A.; Rosenkranz, M.; Schmidt, H.; Sedghi, A.; Siepmann, T.; Szabo, K.; Thomalla, G.; Palaiodimou, L.; Sagris, D.; Kargiotis, O.; Kaliaev, A.; Liebeskind, D.; Hassan, A.; Ranta, A.; Devlin, T.; Zaidat, O.; Castonguay, A.; Jovin, T.; Tsivgoulis, G.; Malik, A.; Ma, A.; Campbell, B.; Kleinig, T.; Wu, T.; Gongora, F.; Lavados, P.; Olavarria, V.; Lereis, V. P.; Corredor, A.; Barbosa, D. M.; Bayona, H.; Barrientos, J. D.; Patino, M.; Thijs, V.; Pirson, A.; Kristoffersen, E. S.; Patrik, M.; Fischer, U.; Bernava, G.; Renieri, L.; Strambo, D.; Ayo-Martin, O.; Montaner, J.; Karlinski, M.; Cruz-Culebras, A.; Luchowski, P.; Krastev, G.; Arenillas, J.; Gralla, J.; Mangiafico, S.; Blasco, J.; Fonseca, L.; Silva, M. L.; Kwan, J.; Banerjee, S.; Sangalli, D.; Frisullo, G.; Yavagal, D.; Uyttenboogaart, M.; Bandini, F.; Adami, A.; de Lecina, M. A.; Arribas, M. A. T.; Ferreira, P.; Cruz, V. T.; Nunes, A. P.; Marto, J. P.; Rodrigues, M.; Melo, T.; Saposnik, G.; Scott, C. A.; Shuaib, A.; Khosravani, H.; Fields, T.; Shoamanesh, A.; Catanese, L.; Mackey, A.; Hill, M.; Etherton, M.; Rost, N.; Lutsep, H.; Lee, V.; Mehta, B.; Pikula, A.; Simmons, M.; Macdougall, L.; Silver, B.; Khandelwal, P.; Morris, J.; Novakovic-White, R.; Ramakrishnan, P.; Shah, R.; Altschul, D.; Almufti, F.; Amaya, P.; Ordonez, C. E. R.; Lara, O.; Kadota, L. R.; Rivera, L. I. P.; Novarro, N.; Escobar, L. D.; Melgarejo, D.; Cardozo, A.; Blanco, A.; Zelaya, J. A.; Luraschi, A.; Gonzalez, V. H. N.; Almeida, J.; Conforto, A.; Almeida, M. S.; Silva, L. D.; Cuervo, D. L. M.; Zetola, V. F.; Martins, R. T.; Valler, L.; Giacomini, L. V.; Cardoso, F. B.; Sahathevan, R.; Hair, C.; Hankey, G.; Salazar, D.; Lima, F. O.; Mont'Alverne, F.; Moises, D.; Iman, B.; Magalhaes, P.; Longo, A.; Rebello, L.; Falup-Pecurariu, C.; Mazya, M.; Wisniewska, A.; Fryze, W.; Kazmierski, R.; Wisniewska, M.; Horoch, E.; Sienkiewicz-Jarosz, H.; Fudala, M.; Rogoziewicz, M.; Brola, W.; Sobolewski, P.; Kaczorowski, R.; Stepien, A.; Klivenyi, P.; Szapary, L.; van den Wijngaard, I.; Demchuk, A.; Abraham, M.; Alvarado-Ortiz, T.; Kaushal, R.; Ortega-Gutierrez, S.; Farooqui, M.; Bach, I.; Badruddin, A.; Barazangi, N.; Nguyen, C.; Brereton, C.; Choi, J. H.; Dharmadhikari, S.; Desai, K.; Doss, V.; Edgell, R.; Linares, G.; Frei, D.; Chaturvedi, S.; Gandhi, D.; Chaudhry, S.; Choe, H.; Grigoryan, M.; Gupta, R.; Helenius, J.; Voetsch, B.; Khwaja, A.; Khoury, N.; Kim, B. S.; Kleindorfer, D.; McDermott, M.; Koyfman, F.; Leung, L.; Linfante, I.; Male, S.; Masoud, H.; Min, J. Y.; Mittal, M.; Multani, S.; Nahab, F.; Nalleballe, K.; Rahangdale, R.; Rafael, J.; Rothstein, A.; Ruland, S.; Sharma, M.; Singh, A.; Starosciak, A.; Strasser, S.; Szeder, V.; Teleb, M.; Tsai, J.; Mohammaden, M.; Pineda-Franks, C.; Asyraf, W.; Nguyen, T. Q.; Tarkanyi, G.; Horev, A.; Haussen, D.; Balaguera, O.; Vasquez, A. R.; Nogueira, R..

Neurology ; 96(15):42, 2021.

Article in English | Web of Science | ID: covidwho-1576349

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Nguyen, T.; Qureshi, M.; Martins, S.; Yamagami, H.; Qiu, Z.; Mansour, O.; Czlonkowska, A.; Abdalkader, M.; Sathya, A.; Sousa, D. A.; Demeester, J.; Mikulik, R.; Vanacker, P.; Siegler, J.; Korv, J.; Biller, J.; Liang, C.; Sangha, N.; Zha, A.; Czap, A.; Holmstedt, C.; Turan, T.; Grant, C.; Ntaios, G.; Malhotra, K.; Tayal, A.; Loochtan, A.; Mistry, E.; Alexandrov, A.; Huang, D.; Yaghi, S.; Raz, E.; Sheth, S.; Frankel, M.; Lamou, E. G. B.; Aref, H.; Elbassiouny, A.; Hassan, F.; Mustafa, W.; Menecie, T.; Shokri, H.; Roushdy, T.; Sarfo, F. S.; Alabi, T.; Arabambi, B.; Nwazor, E.; Sunmonu, T. A.; Wahab, K. W.; Mohammed, H. H.; Adebayo, P. B.; Riahi, A.; Sassi, S. B.; Gwaunza, L.; Rahman, A.; Ai, Z.; Bai, F.; Duan, Z.; Hao, Y.; Huang, W.; Li, G.; Li, W.; Liu, G.; Luo, J.; Shang, X.; Sui, Y.; Tian, L.; Wen, H.; Wu, B.; Yan, Y.; Yuan, Z.; Zhang, H.; Zhang, J.; Zhao, W.; Zi, W.; Leung, T. K.; Sahakyan, D.; Chugh, C.; Huded, V.; Menon, B.; Pandian, J.; Sylaja, P. N.; Usman, F. S.; Farhoudi, M.; Sadeghi-Hokmabadi, E.; Reznik, A.; Sivan-Hoffman, R.; Horev, A.; Ohara, N.; Sakai, N.; Watanabe, D.; Yamamoto, R.; Doijiri, R.; Kuda, N.; Yamada, T.; Terasaki, T.; Yazawa, Y.; Uwatoko, T.; Dembo, T.; Shimizu, H.; Sugiura, Y.; Miyashita, F.; Fukuda, H.; Miyake, K.; Shimbo, J.; Sugimura, Y.; Yagita, Y.; Takenobu, Y.; Matsumaru, Y.; Yamada, S.; Kono, R.; Kanamaru, T.; Yamazaki, H.; Sakaguchi, M.; Todo, K.; Yamamoto, N.; Sonodda, K.; Yoshida, T.; Hashimoto, H.; Nakahara, I.; Faizullina, K.; Kamenova, S.; Kondybayev, A.; Zhanuzakov, M.; Baek, J. H.; Hwang, Y.; Lee, S. B.; Moon, J.; Park, H.; Seo, J. H.; Seo, K. D.; Young, C. J.; Ahdab, R.; Aziz, Z. A.; Zaidi, W. A. W.; Basr, H. B.; Chung, L. W.; Husin, M.; Ibrahim, A. B.; Ibrahim, K. A.; Looi, I.; Tan, W. Y.; Yahya, W. N. W.; Groppa, S.; Leahu, P.; Hashmi, A. A.; Imam, Y. Z.; Akhtar, N.; Oliver, C.; Kandyba, D.; Alhazzani, A.; Al-Jehani, H.; Tham, C. H.; Mamauag, M. J.; Narayanaswamy, R.; Chen, C. H.; Tang, S. C.; Churojana, A.; Aykaç, O.; Özdemir, A.; Hussain, S. I.; John, S.; Vu, H. L.; Tran, A. D.; Nguyen, H. H.; Thong, P. N.; Nguyen, T.; Nguyen, T.; Gattringer, T.; Enzinger, C.; Killer-Oberpfalzer, M.; Bellante, F.; Deblauwe, S.; Hooren, G. V.; Raedt, S. D.; Dusart, A.; Ligot, N.; Rutgers, M.; Yperzeele, L.; Alexiev, F.; Sakelarova, T.; Bedekovic, M.; Budincevic, H.; Cindric, I.; Hucika, Z.; Ozretic, D.; Saric, M. S.; Pfeifer, F.; Karpowicz, I.; Cernik, D.; Sramek, M.; Skoda, M.; Hlavacova, H.; Klecka, L.; Koutny, M.; Skoda, O.; Fiksa, J.; Hanelova, K.; Nevsimalova, M.; Rezek, R.; Prochazka, P.; Krejstova, G.; Neumann, J.; Vachova, M.; Brzezanski, H.; Hlinovsky, D.; Tenora, D.; Jura, R.; Jurak, L.; Novak, J.; Novak, A.; Topinka, Z.; Fibrich, P.; Sobolova, H.; Volny, O.; Christensen, H. K.; Drenck, N.; Iversen, H.; Simonsen, C.; Truelsen, T.; Wienecke, T.; Vibo, R.; Gross-Paju, K.; Toomsoo, T.; Antsov, K.; Caparros, F.; Cordonnier, C.; Dan, M.; Faucheux, J. M.; Mechtouff, L.; Eker, O.; Lesaine, E.; Pico, F.; Pop, R.; Rouanet, F.; Gubeladze, T.; Khinikadze, M.; Lobjanidze, N.; Tsiskaridze, A.; Nagel, S.; Arthurringleb, P.; Rosenkranz, M.; Schmidt, H.; Sedghi, A.; Siepmann, T.; Szabo, K.; Thomalla, G.; Palaiodimou, L.; Sagris, D.; Kargiotis, O.; Kaliaev, A.; Liebeskind, D.; Hassan, A.; Ranta, A.; Devlin, T.; Zaidat, O.; Castonguay, A.; Jovin, T.; Tsivgoulis, G.; Malik, A.; Ma, A.; Campbel, B.; Kleinig, T.; Wu, T.; Gongora, F.; Lavados, P.; Olavarria, V.; Lereis, V. P.; Corredor, A.; Barbosa, D. M.; Bayona, H.; Barrientos, J. D.; Patino, M.; Thijs, V.; Pirson, A.; Kristoffersen, E. S.; Patrik, M.; Fischer, U.; Bernava, G.; Renieri, L.; Strambo, D.; Ayo-Martin, O.; Montaner, J.; Karlinski, M.; Cruz-Culebras, A.; Luchowski, P.; Krastev, G.; Arenillas, J.; Gralla, J.; Mangiafico, S.; Blasco, J.; Fonseca, L.; Silva, M. L.; Kwan, J.; Banerjee, S.; Sangalli, D.; Frisullo, G.; Yavagal, D.; Uyttenboogaart, M.; Bandini, F.; Adami, A.; Lecina, M. A. D.; Arribas, M. A. T.; Ferreira, P.; Cruz, V. T.; Nunes, A. P.; Marto, J. P.; Rodrigues, M.; Melo, T.; Saposnik, G.; Scott, C. A.; Shuaib, A.; Khosravani, H.; Fields, T.; Shoamanesh, A.; Catanese, L.; MacKey, A.; Hill, M.; Etherton, M.; Rost, N.; Lutsep, H.; Lee, V.; Mehta, B.; Pikula, A.; Simmons, M.; MacDougall, L.; Silver, B.; Khandelwal, P.; Morris, J.; Novakovic-White, R.; Shah, R.; Altschul, D.; Almufti, F.; Amaya, P.; Ordonez, C. E. R.; Lara, O.; Kadota, L. R.; Rivera, L. I.; Novarro, N.; Escobar, L. D.; Melgarejo, D.; Cardozo, A.; Blanco, A.; Zelaya, J. A.; Luraschi, A.; Gonzalez, V. H.; Almeida, J.; Conforto, A.; Almeida, M. S.; Silva, L. D. D.; Cuervo, D. L. M.; Zetola, V. F.; Martins, R. T.; Valler, L.; Giacomini, L. V.; Buchdidcardoso, F.; Sahathevan, R.; Hair, C.; Hankey, G.; Salazar, D.; Lima, F. O.; Mont'alverne, F.; Iman, D. M. B.; Longo, A.; Rebello, L.; Falup-Pecurariu, C.; Mazya, M.; Wisniewska, A.; Fryze, W.; Kazmierski, R.; Wisniewska, M.; Horoch, E.; Sienkiewicz-Jarosz, H.; Fudala, M.; Goziewicz, M.; Brola, W.; Sobolewski, P.; Kaczorowski, R.; Stepien, A.; Klivenyi, P.; Szapary, L.; Wijngaard, I. V. D.; Demchuk, A.; Abraham, M.; Alvarado-Ortiz, T.; Kaushal, R.; Ortega-Gutierrez, S.; Farooqui, M.; Bach, I.; Badruddin, A.; Barazangi, N.; Nguyen, C.; Brereton, C.; Choi, J. H.; Dharmadhikari, S.; Desai, K.; Doss, V.; Edgell, R.; Linares, G.; Frei, D.; Chaturvedi, S.; Gandhi, D.; Chaudhry, S.; Choe, H.; Grigoryan, M.; Gupta, R.; Helenius, J.; Voetsch, B.; Khwaja, A.; Khoury, N.; Kim, B. S.; Kleindorfer, D.; McDermott, M.; Koyfman, F.; Leung, L.; Linfante, I.; Male, S.; Masoud, H.; Min, J.; Mittal, M.; Multani, S.; Nahab, F.; Nalleballe, K.; Rahangdale, R.; Rafael, J.; Rothstein, A.; Ruland, S.; Sharma, M.; Singh, A.; Starosciak, A.; Strasser, S.; Szeder, V.; Teleb, M.; Tsai, J.; Mohammaden, M.; Pineda-Franks, C.; Asyraf, W.; Nguyen, T. Q.; Tarkanyi, A.; Haussen, D.; Balaguera, O.; Rodriguezvasquez, A.; Nogueira, R..

Neurology ; 96(15 SUPPL 1), 2021.

Article in English | EMBASE | ID: covidwho-1407898

ABSTRACT

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

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