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Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.
Marto, João Pedro; Strambo, Davide; Ntaios, George; Nguyen, Thanh N; Herzig, Roman; Czlonkowska, Anna; Demeestere, Jelle; Mansour, Ossama Yassin; Salerno, Alexander; Wegener, Susanne; Baumgartner, Philipp; Cereda, Carlo W; Bianco, Giovanni; Beyeler, Morin; Arnold, Marcel; Carrera, Emmanuel; Machi, Paolo; Altersberger, Valerian; Bonati, Leo; Gensicke, Henrik; Bolognese, Manuel; Peters, Nils; Wetzel, Stephan; Magriço, Marta; Ramos, João Nuno; Sargento-Freitas, João; Machado, Rita; Maia, Carolina; Machado, Egídio; Nunes, Ana Paiva; Ferreira, Patricia; Pinho E Melo, Teresa; Dias, Mariana Carvalho; Paula, André; Correia, Manuel Alberto; Castro, Pedro; Azevedo, Elsa; Albuquerque, Luís; Alves, José Nuno; Ferreira-Pinto, Joana; Meira, Torcato; Pereira, Liliana; Rodrigues, Miguel; Araujo, Andre Pinho; Rodrigues, Marta; Rocha, Mariana; Pereira-Fonseca, Ângelo; Ribeiro, Luís; Varela, Ricardo; Malheiro, Sofia.
  • Marto JP; Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal joao.pedro.seabra.marto@gmail.com.
  • Strambo D; Stroke Centre, Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Lausanne, Switzerland.
  • Ntaios G; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
  • Nguyen TN; Department of Neurology, Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
  • Herzig R; Department of Neurology, Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic.
  • Czlonkowska A; 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland.
  • Demeestere J; Neurology Department, Leuven University Hospital, Leuven, Belgium.
  • Mansour OY; Alexandria University Hospitals and Affiliated Stroke Network, Alexandria, Egypt.
  • Salerno A; Stroke Centre, Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Lausanne, Switzerland.
  • Wegener S; Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.
  • Baumgartner P; Department of Neurology, University Hospital of Zurich, Zurich, Switzerland.
  • Cereda CW; Stroke Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.
  • Bianco G; Stroke Center, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland.
  • Beyeler M; Stroke Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
  • Arnold M; Stroke Center, Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland.
  • Carrera E; Stroke Centre, Geneva University Hospital, Geneva, Switzerland.
  • Machi P; Department of Neuroradiology, Geneva University Hospital, Geneva, Switzerland.
  • Altersberger V; Stroke Centre, University Hospital Basel and University of Basel, Switzerland.
  • Bonati L; Stroke Centre, University Hospital Basel and University of Basel, Switzerland.
  • Gensicke H; Stroke Centre, University Hospital Basel and University of Basel, Switzerland.
  • Bolognese M; Stroke Centre, Kantonsspital Lucerne, Switzerland.
  • Peters N; Stroke Centre, Hirslanden Hospital, Zurich, Switzerland.
  • Wetzel S; Stroke Centre, Hirslanden Hospital, Zurich, Switzerland.
  • Magriço M; Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Ramos JN; Department of Neuroradiology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Sargento-Freitas J; Department of Neurology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
  • Machado R; Department of Neurology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
  • Maia C; Department of Neurology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
  • Machado E; Department of Neuroradiology, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal.
  • Nunes AP; Stroke Unit, Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
  • Ferreira P; Stroke Unit, Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
  • Pinho E Melo T; Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
  • Dias MC; Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
  • Paula A; Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
  • Correia MA; Department of Neuroradiology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
  • Castro P; Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal.
  • Azevedo E; Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal.
  • Albuquerque L; Department of Neuroradiology, Centro Hospitalar Universitário São João, Porto, Portugal.
  • Alves JN; Department of Neurology, Hospital de Braga, Braga, Portugal.
  • Ferreira-Pinto J; Department of Neurology, Hospital de Braga, Braga, Portugal.
  • Meira T; Department of Neuroradiology, Hospital de Braga, Braga, Portugal.
  • Pereira L; Department of Neurology, Hospital Garcia de Orta, Almada, Portugal.
  • Rodrigues M; Department of Neurology, Hospital Garcia de Orta, Almada, Portugal.
  • Araujo AP; Department of Neuroradiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
  • Rodrigues M; Department of Neuroradiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
  • Rocha M; Department of Neurology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
  • Pereira-Fonseca Â; Department of Neurology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
  • Ribeiro L; Department of Neurology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
  • Varela R; Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
  • Malheiro S; Department of Neurology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Neurology ; 2022 Nov 09.
Article in English | MEDLINE | ID: covidwho-2243164
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.

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2022 Document Type: Article Affiliation country: Wnl.0000000000201537

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Year: 2022 Document Type: Article Affiliation country: Wnl.0000000000201537