Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19 The Global COVID-19 Stroke Registry

Authors	MARTO Joao Pedro STRAMBO Davide N NTAIOS George NGUYEN Thanh HERZIG Roman CZLONKOWSKA Anna DEMEESTERE Jelle MANSOUR Ossama Yassin SALERNO Alexander WEGENER Susanne W BAUMGARTNER Philipp CEREDA Carlo BIANCO Giovanni BEYELER Morin ARNOLD Marcel CARRERA Emmanuel MACHI Paolo ALTERSBERGER Valerian BONATI Leo GENSICKE Henrik BOLOGNESE Manuel PETERS Nils WETZEL Stephan MAGRICO Marta RAMOS Joao Nuno SARGENTO-FREITAS Joao MACHADO Rita MAIA Carolina MACHADO Egidio NUNES Ana Paiva FERREIRA Patricia TERESA Pinho e Melo DIAS Mariana Carvalho PAULA Andre CORREIA Manuel Alberto CASTRO Pedro AZEVEDO Elsa ALBUQUERQUE Luis ALVES Jose Nuno FERREIRA-PINTO Joana MEIRA Torcato PEREIRA Liliana RODRIGUES Miguel ARAUJO Andre Pinho RODRIGUES Marta ROCHA Mariana PEREIRA-FONSECA Angelo RIBEIRO Luis VARELA Ricardo MALHEIRO Sofia CAPPELLARI Manuel ZIVELONGHI Cecilia SAJEVA Giulia ZINI Andrea GENTILE Mauro FORLIVESI Stefano MIGLIACCIO Ludovica SESSA Maria SARA La Gioia PEZZINI Alessandro SANGALLI Davide ZEDDE Marialuisa PASCARELLA Rosario FERRARESE Carlo BERETTA Simone DIAMANTI Susanna SCHWARZ Ghil FRISULLO Giovanni MARCHESELLI Simona SENERS Pierre SABBEN Candice ESCALARD Simon PIOTIN Michel MAIER Benjamin CHARBONNIER Guillaume VUILLIER Fabrice LEGRIS Loic R CUISENIER Pauline VODRET Francesca MARNAT Gaultier LIEGEY Jean-Sebastien SIBON Igor FLOTTMANN Fabian BROOCKS Gabriel O GLOYER Nils-Ole BOHMANN Ferdinand SCHAEFER Jan Hendrik J NOLTE Christian AUDEBERT Heinrich SIEBERT Eberhard SYKORA Marek LANG Wilfried FERRARI Julia MAYER-SUESS Lukas KNOFLACH Michael GIZEWSKI Elke Ruth J STOLP Jeffrey M STOLZE Lotte COUTINHO Jonathan NEDERKOORN Paul IDO van den Wijngaard JOKE De Meris LEMMENS Robin SYLVIE De Raedt VANDERVORST Fenne RUTGERS Matthieu Pierre GUILMOT Antoine DUSART Anne BELLANTE Flavio CALLEJA-CASTANO Patricia OSTOS Fernando GONZALEZ-ORTEGA Guillermo MARTIN-JIMENEZ Paloma GARCIA-MADRONA Sebastian CRUZ-CULEBRAS Antonio VERA Rocio MATUTE Maria Consuelo FUENTES Blanca ALONSO-DE-LECINANA Maria RIGUAL Ricardo DIEZ-TEJEDOR Exuperio PEREZ-SANCHEZ Soledad MONTANER Joan DIAZ-OTERO Fernando PEREZ-DE-LA-OSSA Natalia FLORES-PINA Belen MUNOZ-NARBONA Lucia CHAMORRO Angel RODRIGUEZ-VAZQUEZ Alejandro RENU Arturo AYO-MARTIN Oscar HERNANDEZ-FERNANDEZ Francisco SEGURA Tomas TEJADA-MEZA Herbert SAGARRA-MUR Daniel SERRANO-PONZ Marta HLAING Thant SEE Isaiah SIMISTER Robert WERRING David KRISTOFFERSEN Espen Saxhaug NORDANSTIG Annika JOOD Katarina RENTZOS Alexandros SIMUNEK Libor KRAJICKOVA Dagmar KRAJINA Antonín MIKULÍK Robert CVIKOVÁ Martina VINKLÁREK Jan SKOLOUDIK David ROUBEC Martin HURTIKOVA Eva HRUBY Rostislav OSTRY Svatopluk SKODA Ondrej PERNICKA Marek JURAK Lubomir EICHLOVA Zuzana JIRA Martin KOVAR Martin PANSKY Michal MENCL Pavel PALOUSKOVA Hana TOMEK Ales JANSKY Petr OLSEROVA Anna SRAMEK Martin HAVLICEK Roman MALY Petr TRAKAL Lukas FIKSA Jan SLOVAK Matej KARLINSKI Michal Adam NOWAK Maciej SIENKIEWICZ-JAROSZ Halina BOCHYNSKA Anna WRONA Pawel HOMA Tomasz SAWCZYNSKA Katarzyna SLOWIK Agnieszka WLODARCZYK Ewa WIACEK Marcin TOMASZEWSKA-LAMPART Izabella SIECZKOWSKI Bartosz BARTOSIK-PSUJEK Halina BILIK Marta BANDZAREWICZ Anna DOROBEK Malgorzata ZIELINSKA-TUREK Justyna NOWAKOWSKA-KOTAS Marta OBARA Krystian URBANOWSKI Pawel BUDREWICZ Slawomir GUZINSKI Maciej SWITONSKA Milena RUTKOWSKA Iwona SOBIESZAK-SKURA Paulina M LABUZ-ROSZAK Beata DEBIEC Aleksander STASZEWSKI Jacek STEPIEN Adam ZWIERNIK Jacek WASILEWSKI Grzegorz TIU Cristina TERECOASA Elena Oana RADU Razvan Alexandru NEGRILA Anca DOROBAT Bogdan PANEA Cristina TIU Vlad PETRESCU Simona OZDEMIR Atilla MAHMOUD Mostafa EL-SAMAHY Hussam ABDELKHALEK Hazem AL-HASHEL Jasem ISMAIL Ismail Ibrahim SALMEEN Athari GHOREISHI Abdoreza SABETAY Sergiu Ionut GROSS Hana KLEIN Piers ABDALKADER Mohamad JABBOUR Pascal KAREEM El Naamani TJOUMAKARIS Stavropoula ABBAS Rawad A MOHAMED Ghada CHEBL Alex MIN Jiangyong HOVINGH Majesta P TSAI Jenney KHAN Muhib NALLEBALLE Krishna ONTEDDU Sanjeeva MASOUD Hesham MINA Michael KAUR Navreet MAALI Laith G ABRAHAM Michael KHANDELWAL Priyank BACH Ivo ONG Melody BABICI Denis M KHAWAJA Ayaz HAKEMI Maryam RAJAMANI Kumar CANO-NIGENDA Vanessa ARAUZ Antonio AMAYA Pablo LLANOS Natalia ARANGO Akemi VENCES Miguel Angel DOMINGUO Barrientos Guerra Jose CAETANO Rayllene MARTINS Rodrigo Targa SCOLLO Sergio Daniel YALUNG Patrick Matic NAGENDRA Shashank GAIKWAD Abhijit SEO Kwon-Duk GEORGIOPOULOS Georgios G NOGUEIRA Raul MICHEL Patrik
Year of publication	2023
Type	Article in Periodical
Magazine / Source	Neurology
MU Faculty or unit	Faculty of Medicine
Citation
Web	https://www.neurology.org/doi/10.1212/wnl.0000000000201537
Doi	http://dx.doi.org/10.1212/WNL.0000000000201537
Keywords	THROMBECTOMY; COVID19; endovascular treatment; STROKE
Description	Background and ObjectivesCOVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19.MethodsThis was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 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).ResultsOf a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted 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 mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 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).DiscussionPatients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 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.