EFFICACY AND OUTCOMES OF REPERFUSION THERAPIES FOR ACUTE ISCHEMIC STROKE IN COVID-19 PATIENTS: A NATION-WIDE MULTI-CENTER STUDY

ABSTRACT

Background and aims: Acute ischemic stroke (AIS) is a possible complication of coronavirus disease (COVID-19). Data on reperfusion therapies (RT) - intravenous thrombolysis and endovascular treatment (EVT) - and long-term outcomes in COVID-19 stroke patients is lacking. We sought to evaluate functional outcome (mRS) and 3-month case fatality in COVID-19 stroke patients after RT. Methods: We performed a retrospective nation-wide pair-matched analysis of COVID-19 patients with AIS who underwent RT. We included adult COVID-19 AIS patients, treated with RT between March 16, 2020 and June 30, 2021. All subjects were paired with non-infected controls, matched for age, sex, stroke arterial vascular territory, and RT modality. Results: 31 subjects and 31 matched controls were included. Median baseline NIHSS score in the COVID-19 group was 16, compared to 12 among controls (P=0.028). The timeliness metrics (onset-to-door, doorto- needle and door-to-puncture times) did not differ significantly between the two groups. Rates of ischemic changes and symptomatic intracranial hemorrhages did not differ significantly between the two groups at 24 hours after RT. Higher rate of respiratory failure was observed in the COVID-19 group in compare to controls (64.5% vs. 22%, P = 0.007). Median NIHSS 24 hours after reperfusion was 16 in COVID-19 group and 5 in controls (P=0.003). mRS 0-2 at discharge was observed in 22.6% of COVID-19 patients compared to 51.8% of controls (P=0.018). Threemonth case fatality was 54.8% in COVID-19 group versus 12.9% in controls (P=0.001). Conclusions: COVID-19 positive stroke patients had worse functional outcomes at discharge and higher 3-month case fatality.