1
|
Xue YD, Zheng YY, Cao C, Shi Q. The influence of COVID-19 on short-term mortality in acute ischemic stroke: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e39761. [PMID: 39331947 PMCID: PMC11441880 DOI: 10.1097/md.0000000000039761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 08/29/2024] [Indexed: 09/29/2024] Open
Abstract
OBJECTIVE To evaluate the differences in short-term mortality risk between acute ischemic stroke (AIS) patients with and without SARS-CoV-2 infection. METHODS PubMed, EMBASE, Scopus, and Cochrane Databases were systematically searched from December 1, 2019 to May 20, 2022 using the keywords coronavirus disease 2019 (COVID-19), COVID-19, SARS-CoV-2, and ischemic stroke. A random-effects model was estimated, and subgroup analysis and meta-regressions were performed. The quality of eligible studies was assessed using the Newcastle-Ottawa Scale. RESULTS A total of 26 eligible studies with 307,800 patients were included in this meta-analysis. The overall results show that in-hospital and 90-day mortality was 3.31-fold higher in AIS with SARS-CoV-2 patients compared with those without SARS-CoV-2. When matched for age and National Institutes of Health Stroke Scale score at admission, the risk ratio of in-hospital mortality from AIS among patients with SARS-CoV-2 versus without decreased to 2.83. Reperfusion therapy and endovascular thrombectomy may further reduce the risk of death in patients to some extent but do not increase the incidence of symptomatic intracerebral hemorrhage. Meta-regression showed that in-hospital mortality decreased with increasing National Institutes of Health Stroke Scale score in AIS with SARS-CoV-2 compared to those without SARS-CoV-2 and that the difference in mortality risk between the 2 was independent of age and sex. CONCLUSIONS The results of this study suggest that AIS patients with SARS-CoV-2 have higher short-term mortality compared to AIS patients without SARS-CoV-2, and reperfusion and endovascular thrombectomy therapy may reduce the risk of short-term mortality to some extent. The differences in in-hospital mortality risk were similar across ages and sexes. Focused attention is therefore needed on AIS patients with SARS-CoV-2 to control mortality.
Collapse
Affiliation(s)
- Yi-dong Xue
- Department of Neurology, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Ying-ying Zheng
- Department of Medical Laboratory, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
- Department of Basic Medicine, Medical School of Yan’an University, Yan’an, Shaanxi, China
| | - Chan Cao
- Department of Neurology, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| | - Qiang Shi
- Department of Neurology, Yan’an University Affiliated Hospital, Yan’an, Shaanxi, China
| |
Collapse
|
2
|
Olson MG, Park TD, Alvarez R, Hogan EA, Ovard O, Khanna O, Youssef AS. The effect of SARS-CoV-2 on the incidence of post-operative venous sinus thrombosis following skull base procedures. Acta Neurochir (Wien) 2024; 166:302. [PMID: 39037618 DOI: 10.1007/s00701-024-06197-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/07/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Sinus thrombosis is a common post-operative finding after posterior fossa surgery performed in the vicinity of the dural venous sinuses. The SARS-CoV-2 virus has been shown to confer an increased risk of venous thromboembolic events owing to eliciting a hyper-inflammatory and pro-thrombotic state. In this study, we examine the incidence of post-operative venous sinus thrombosis in patients undergoing peri-sigmoid posterior fossa surgery in the pre- and post-COVID era and investigate whether COVID infection confers an increased risk of sinus thrombosis. METHODS A retrospective review of a single institution case series of patients underwent peri-sigmoid surgery (retrosigmoid, translabyrinthine, or far lateral) approach. Relevant clinical variables were investigated that may confer an increased risk of sinus thrombosis. RESULTS A total of 311 patients (178 in the pre-COVID era, and 133 operated on after the pandemic began in March 2020) are included in the study. The composite incidence of sinus thrombosis seen on post-operative imaging was 7.8%. The incidence of sinus thrombosis in the pre-COVID cohort was N = 12 patients (6.7%) versus N = 12 (9%) in the post-COVID cohort (p = 0.46). A history of COVID infection was not shown to confer an increased risk of post-operative sinus thrombosis (OR: 0.61; 95% CI: 0.08-4.79, p = 0.64). Only a small number of patients (N = 7, 2.3%) required either medical or surgical intervention for post-operative sinus thrombosis. CONCLUSION The overall incidence of post-operative sinus thrombosis is similar in the pre- and post-COVID era. The findings of this study suggest that COVID infection is not associated with a higher risk of venous sinus thrombosis.
Collapse
Affiliation(s)
- Madeline G Olson
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Tyler D Park
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Reinier Alvarez
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Elizabeth A Hogan
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Olivia Ovard
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Omaditya Khanna
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
- Department of Otolaryngology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
| |
Collapse
|
3
|
Ünverdi CM, Haki C, Saraç K, Kamışlı S. Comparison of radiological and clinical characteristics of COVID-19 positive and negative ischemic stroke patients undergoing revascularization: A single-centre Turkish study. Clin Neurol Neurosurg 2024; 242:108324. [PMID: 38749359 DOI: 10.1016/j.clineuro.2024.108324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE We aimed to compare the radiological and clinical characteristics of COVID-19-positive and -negative acute ischemic stroke (AIS) patients who underwent revascularization and to evaluate whether COVID-19 has an effect on revascularization and outcome in AIS patients with COVID-19 infection. METHODS Consecutive COVID-19 positive and negative AIS patients who underwent intravenous thrombolysis and/or endovascular therapy in our hospital between March 2020 and February 2022 were included in this study. Our study is retrospective and 23 COVID-19 positive patients and 108 COVID-19 negative patients were compared in terms of radiological and clinical characteristics. RESULTS Hypertension was lower in the COVID-19 positive ischemic stroke group (p=0.029). Admission NIHSS score was higher in COVID-19 positive patients (p=0.041). ASPECTS was found to be lower in COVID-19 positive ischemic stroke patients (p=0.019). The rate of hyperdense artery sign differed between groups (p=0.014) and was higher in the COVID-19 positive ischemic stroke group. The incidence of multi-vessel occlusion was found to be significantly higher in the COVID-19-positive ischemic stroke group (p=0.002). In terms of prognostic features, only the 3-month good outcome rate was statistically significantly lower in the COVID-19-positive ischemic stroke group (p=0.011). CONCLUSION This study found that radiologically, COVID-19 may be associated with lower ASPECTS in ischemic stroke patients receiving revascularization treatment and may predispose to multivessel occlusion and hyperdense artery sign. Clinically, COVID-19 may be associated with a more severe initial presentation and worse prognosis at 3 months in ischemic stroke patients undergoing revascularization, but may not affect long-term mortality.
Collapse
Affiliation(s)
- Cenk Murat Ünverdi
- Department of Neurology, University of Health Sciences, Bursa Faculty of Medicine, Bursa City Hospital, Bursa, Turkey.
| | - Cemile Haki
- Department of Neurology, University of Health Sciences, Bursa Faculty of Medicine, Bursa City Hospital, Bursa, Turkey
| | - Kaya Saraç
- Department of Radiology, University of Health Sciences, Bursa Faculty of Medicine, Bursa City Hospital, Bursa, Turkey
| | - Suat Kamışlı
- Department of Neurology, University of Health Sciences, Bursa Faculty of Medicine, Bursa City Hospital, Bursa, Turkey
| |
Collapse
|
4
|
Deuschl C, Goertz L, Kabbasch C, Köhrmann M, Kleinschnitz C, Berlis A, Maurer CJ, Mühlen I, Kallmünzer B, Gawlitza M, Kaiser DPO, Klisch J, Lobsien D, Behme D, Thormann M, Flottmann F, Winkelmeier L, Gizewski ER, Mayer‐Suess L, Holtmannspoetter M, Moenninghoff C, Schlunz‐Hendann M, Grieb D, Arendt CT, Bohmann FO, Altenbernd J, Li Y, Sure U, Mühl‐Benninghaus R, Rodt T, Kallenberg K, Durutya A, Elsharkawy M, Stracke C, Schumann MG, Bock A, Nikoubashman O, Wiesmann M, Henkes H, Dolff S, Demircioglu A, Forsting M, Styczen H. Impact of Vaccination Status on Outcome of Patients With COVID-19 and Acute Ischemic Stroke Undergoing Mechanical Thrombectomy. J Am Heart Assoc 2024; 13:e031816. [PMID: 38639365 PMCID: PMC11179949 DOI: 10.1161/jaha.123.031816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Data on impact of COVID-19 vaccination and outcomes of patients with COVID-19 and acute ischemic stroke undergoing mechanical thrombectomy are scarce. Addressing this subject, we report our multicenter experience. METHODS AND RESULTS This was a retrospective analysis of patients with COVID-19 and known vaccination status treated with mechanical thrombectomy for acute ischemic stroke at 20 tertiary care centers between January 2020 and January 2023. Baseline demographics, angiographic outcome, and clinical outcome evaluated by the modified Rankin Scale score at discharge were noted. A multivariate analysis was conducted to test whether these variables were associated with an unfavorable outcome, defined as modified Rankin Scale score >3. A total of 137 patients with acute ischemic stroke (48 vaccinated and 89 unvaccinated) with acute or subsided COVID-19 infection who underwent mechanical thrombectomy attributable to vessel occlusion were included in the study. Angiographic outcomes between vaccinated and unvaccinated patients were similar (modified Thrombolysis in Cerebral Infarction ≥2b: 85.4% in vaccinated patients versus 86.5% in unvaccinated patients; P=0.859). The rate of functional independence (modified Rankin Scale score, ≤2) was 23.3% in the vaccinated group and 20.9% in the unvaccinated group (P=0.763). The mortality rate was 30% in both groups. In the multivariable analysis, vaccination status was not a significant predictor for an unfavorable outcome (P=0.957). However, acute COVID-19 infection remained significant (odds ratio, 1.197 [95% CI, 1.007-1.417]; P=0.041). CONCLUSIONS Our study demonstrated no impact of COVID-19 vaccination on angiographic or clinical outcome of COVID-19-positive patients with acute ischemic stroke undergoing mechanical thrombectomy, whereas worsening attributable to COVID-19 was confirmed.
Collapse
Affiliation(s)
- Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenEssenGermany
| | - Lukas Goertz
- Department of Diagnostic and Interventional RadiologyUniversity Hospital CologneCologneGermany
| | - Christoph Kabbasch
- Department of Diagnostic and Interventional RadiologyUniversity Hospital CologneCologneGermany
| | - Martin Köhrmann
- Department of Neurology and Center for Translational Neurosciences and Behavioral SciencesUniversity Hospital EssenEssenGermany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational Neurosciences and Behavioral SciencesUniversity Hospital EssenEssenGermany
| | - Ansgar Berlis
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital AugsburgAugsburgGermany
| | - Christoph Johannes Maurer
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital AugsburgAugsburgGermany
| | - Iris Mühlen
- Department of NeuroradiologyUniversity of Erlangen‐NurembergErlangenGermany
| | - Bernd Kallmünzer
- Department of NeurologyUniversity of Erlangen‐NurembergErlangenGermany
| | - Matthias Gawlitza
- Faculty of Medicine, Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
- Department of NeuroradiologyUniversity Hospital LeipzigLeipzigGermany
| | - Daniel P. O. Kaiser
- Faculty of Medicine, Institute and Policlinic of Neuroradiology, University Hospital Carl Gustav CarusTechnische Universität DresdenDresdenGermany
| | - Joachim Klisch
- Department of Diagnostic and Interventional Radiology and NeuroradiologyHelios General Hospital ErfurtErfurtGermany
| | - Donald Lobsien
- Department of Diagnostic and Interventional Radiology and NeuroradiologyHelios General Hospital ErfurtErfurtGermany
| | - Daniel Behme
- Department of NeuroradiologyUniversity Hospital MagdeburgMagdeburgGermany
| | | | - Fabian Flottmann
- Department of Diagnostic and Interventional NeuroradiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Laurens Winkelmeier
- Department of Diagnostic and Interventional NeuroradiologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Elke Ruth Gizewski
- Department of NeuroradiologyMedical University InnsbruckInnsbruckAustria
| | | | | | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear MedicineJohannes Wesling University Hospital, Ruhr University BochumBochumGermany
| | - Martin Schlunz‐Hendann
- Department of Radiology and NeuroradiologyKlinikum Duisburg–Sana KlinikenDuisburgGermany
| | - Dominik Grieb
- Department of Radiology and NeuroradiologyKlinikum Duisburg–Sana KlinikenDuisburgGermany
- Department of Diagnostic and Interventional NeuroradiologyMedical School HannoverHannoverGermany
| | - Christophe T. Arendt
- Institute of Neuroradiology, University HospitalGoethe UniversityFrankfurt am MainGermany
| | - Ferdinand O. Bohmann
- Institute of Neuroradiology, University HospitalGoethe UniversityFrankfurt am MainGermany
| | - Jens Altenbernd
- Department of Radiology and NeuroradiologyGemeinschaftskrankenhaus HerdeckeHerdeckeGermany
| | - Yan Li
- Institute for Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenEssenGermany
| | - Ulrich Sure
- Department of Neurosurgery and Spine SurgeryUniversity Hospital of EssenEssenGermany
| | | | - Thomas Rodt
- Department of RadiologyKlinikum LueneburgLueneburgGermany
| | | | | | | | | | | | - Alexander Bock
- Department of NeuroradiologyVivantes Klinikum NeukoellnBerlinGermany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital, Rheinisch‐Westfälische Technische Hochschule Aachen UniversityAachenGermany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional NeuroradiologyUniversity Hospital, Rheinisch‐Westfälische Technische Hochschule Aachen UniversityAachenGermany
| | - Hans Henkes
- Clinic for NeuroradiologyKlinikum StuttgartStuttgartGermany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious DiseasesUniversity Hospital EssenEssenGermany
| | - Aydin Demircioglu
- Institute for Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenEssenGermany
| | - Michael Forsting
- Institute for Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenEssenGermany
| | - Hanna Styczen
- Institute for Diagnostic and Interventional Radiology and NeuroradiologyUniversity Hospital EssenEssenGermany
| |
Collapse
|
5
|
Dehkharghani S, Vogel A, Jandhyala N, Chung C, Shu L, Frontera J, Yaghi S. Continued Infarction Growth and Penumbral Consumption After Reperfusion in Vaccine-Naive Patients With COVID-19: A Case-Control Study. AJR Am J Roentgenol 2023; 221:517-525. [PMID: 37195793 DOI: 10.2214/ajr.23.29296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND. Neurologic sequelae of SARS-CoV-2 include potentially malignant cerebrovascular events arising from complex hemodynamic, hematologic, and inflammatory processes occurring in concert. OBJECTIVE. This study concerns the hypothesis that despite angiographic reperfusion COVID-19 promotes continued consumption of at-risk tissue volumes after acute ischemic stroke (AIS), yielding critical insights into prognostication and monitoring paradigms in vaccine-naive patients experiencing AIS. METHODS. This retrospective study compared 100 consecutive COVID-19 patients with AIS presenting between March 2020 and April 2021 with a contemporaneous cohort of 282 AIS patients without COVID-19. Reperfusion classes were dichotomized into positive (extended thrombolysis in cerebral ischemia [eTICI] score = 2c-3) and negative (eTICI score < 2c) groups. All patients underwent endovascular therapy after initial CT perfusion imaging (CTP) to document infarction core and total hypoperfusion volumes. RESULTS. Ten COVID-positive (mean age ± SD, 67 ± 12 years; seven men, three women) and 144 COVID-negative patients (mean age, 71 ± 16 years; 76 men, 68 women) undergoing endovascular reperfusion, with antecedent CTP and follow-up imaging, comprised the final dataset. Initial infarction core and total hypoperfusion volumes (mean ± SD) were 1.5 ± 18 mL and 85 ± 100 mL in COVID-negative patients and 30.5 ± 34 mL and 117 ± 80.5 mL in COVID-positive patients, respectively. Final infarction volumes were significantly larger in patients with COVID-19, with median volumes of 77.8 mL versus 18.2 mL among control patients (p = .01), as were normalized measures of infarction growth relative to baseline infarction volume (p = .05). In adjusted logistic parametric regression models, COVID positivity emerged as a significant predictor for continued infarct growth (OR, 5.10 [95% CI, 1.00-25.95]; p = .05). CONCLUSION. These findings support the potentially aggressive clinical course of cerebrovascular events in patients with COVID-19, suggesting greater infarction growth and ongoing consumption of at-risk tissues, even after angiographic reperfusion. CLINICAL IMPACT. SARS-CoV-2 infection may promote continued infarction progression despite angiographic reperfusion in vaccine-naive patients with large-vessel occlusion AIS. The findings carry potential implications for prognostication, treatment selection, and surveillance for infarction growth among revascularized patients in future waves of infection by novel viral strains.
Collapse
Affiliation(s)
- Seena Dehkharghani
- Department of Radiology, New York University Langone Medical Center, Center for Biomedical Imaging, 660 1st Ave, 2nd Fl, New York, NY 10016
- Department of Neurology, New York University Langone Health, New York, NY
| | - Andre Vogel
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Nora Jandhyala
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Charlotte Chung
- Department of Radiology, New York University Langone Medical Center, Center for Biomedical Imaging, 660 1st Ave, 2nd Fl, New York, NY 10016
| | - Liqi Shu
- Department of Neurology, Brown University, Providence, RI
| | - Jennifer Frontera
- Department of Neurology, New York University Langone Health, New York, NY
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI
| |
Collapse
|
6
|
Dallas J, Liu KQ, Wenger TA, Lin M, Ding L, Attenello FJ, Mack WJ. The effect of COVID-19 on treatment and outcomes following ischemic stroke: A national assessment. Clin Neurol Neurosurg 2023; 233:107982. [PMID: 37729801 DOI: 10.1016/j.clineuro.2023.107982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION COVID-19 has had innumerable impacts on the healthcare system, both by worsening patient illness and impeding effective and efficient care. Further, COVID-19 has been tied to increased rates of ischemic stroke, particularly among young patients. We utilized a national database to assess associations of COVID-19 with thrombectomy rates, mortality, and discharge disposition among stroke patients. METHODS Patients were identified from the National Inpatient Sample (NIS, 2020). Inclusion criteria selected for adult ischemic stroke patients; those with venous thrombosis or unspecified cerebral infarction were excluded. Patients were stratified by presence or absence of COVID-19 diagnosis. Outcome variables included mechanical thrombectomy, in-hospital mortality, and discharge disposition. Additional patient demographics, hospital characteristics, and disease severity metrics were collected. Statistical analysis was performed via multivariable logistic regression and log-binary regression. RESULTS 54,368 patients were included in the study; 2116 (3.89%) were diagnosed with COVID-19. COVID-19 was associated with lower rates of mechanical thrombectomy (OR 0.94, p < 0.0001), higher rates of in-hospital mortality (OR 1.14, p < 0.0001), and unfavorable discharge disposition (OR 1.08, p < 0.0001), even when controlling for illness severity. Other relationships, such as a male predominance among stroke patients with COVID-19, were also identified. CONCLUSION This study identified a relationship between COVID-19 diagnosis and worse outcomes for each metric assessed, including mechanical thrombectomy rates, in-hospital mortality, and discharge disposition. Several factors might underly this, ranging from systemic/multisystem inflammation and worsened disease severity to logistical barriers to treatment caused by COVID-19. Further research is needed to determine causality of these findings.
Collapse
Affiliation(s)
- Jonathan Dallas
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Kristie Q Liu
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Talia A Wenger
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Michelle Lin
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Li Ding
- Departement of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Frank J Attenello
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
7
|
Stuckart I, Kabsha A, Siepmann T, Barlinn K, Barlinn J. Intravenous thrombolysis and endovascular therapy for acute ischemic stroke in COVID-19: a systematic review and meta-analysis. Front Neurol 2023; 14:1239953. [PMID: 37681003 PMCID: PMC10482345 DOI: 10.3389/fneur.2023.1239953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/28/2023] [Indexed: 09/09/2023] Open
Abstract
Background The impact of COVID-19 on clinical outcomes in acute ischemic stroke patients receiving reperfusion therapy remains unclear. We therefore aimed to synthesize the available evidence to investigate the safety and short-term efficacy of reperfusion therapy in this patient population. Methods We searched the electronic databases MEDLINE, Embase and Cochrane Library Reviews for randomized controlled trials and observational studies that investigated the use of intravenous thrombolysis, endovascular therapy, or a combination of both in acute ischemic stroke patients with laboratory-confirmed COVID-19, compared to controls. Our primary safety outcomes included any intracerebral hemorrhage (ICH), symptomatic ICH and all-cause in-hospital mortality. Short-term favorable functional outcomes were assessed at discharge and at 3 months. We calculated pooled risk ratios (RR) and 95% confidence intervals (CI) using DerSimonian and Laird random-effects model. Heterogeneity was evaluated using Cochran's Q test and I2 statistics. Results We included 11 studies with a total of 477 COVID-19 positive and 8,092 COVID-19 negative ischemic stroke patients who underwent reperfusion therapy. COVID-19 positive patients exhibited a significantly higher risk of experiencing any ICH (RR 1.54, 95% CI 1.16-2.05, p < 0.001), while the nominally increased risk of symptomatic ICH in these patients did not reach statistical significance (RR 2.04, 95% CI 0.97-4.31; p = 0.06). COVID-19 positive stroke patients also had a significantly higher in-hospital mortality compared to COVID-19 negative stroke patients (RR 2.78, 95% CI 2.15-3.59, p < 0.001). Moreover, COVID-19 positive stroke patients were less likely to achieve a favorable functional outcome at discharge (RR 0.66, 95% CI 0.51-0.86, p < 0.001) compared to COVID-19 negative patients, but this difference was not observed at 3-month follow-up (RR 0.64, 95% CI 0.14-2.91, p = 0.56). Conclusion COVID-19 appears to have an adverse impact on acute ischemic stroke patients who undergo reperfusion therapy, leading to an elevated risk of any ICH, higher mortality and lower likelihood of favorable functional outcome. Systematic review registration PROSPERO, identifier CRD42022309785.
Collapse
Affiliation(s)
- Isabella Stuckart
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ahmed Kabsha
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Division of Health Care Sciences, Center for Clinical Research and Management Education Dresden, Dresden International University, Dresden, Germany
| | - Timo Siepmann
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kristian Barlinn
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jessica Barlinn
- Department of Neurology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
8
|
Siegler JE, Dasgupta S, Abdalkader M, Penckofer M, Yaghi S, Nguyen TN. Cerebrovascular Disease in COVID-19. Viruses 2023; 15:1598. [PMID: 37515284 PMCID: PMC10385090 DOI: 10.3390/v15071598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Not in the history of transmissible illnesses has there been an infection as strongly associated with acute cerebrovascular disease as the novel human coronavirus SARS-CoV-2. While the risk of stroke has known associations with other viral infections, such as influenza and human immunodeficiency virus, the risk of ischemic and hemorrhagic stroke related to SARS-CoV-2 is unprecedented. Furthermore, the coronavirus disease 2019 (COVID-19) pandemic has so profoundly impacted psychosocial behaviors and modern medical care that we have witnessed shifts in epidemiology and have adapted our treatment practices to reduce transmission, address delayed diagnoses, and mitigate gaps in healthcare. In this narrative review, we summarize the history and impact of the COVID-19 pandemic on cerebrovascular disease, and lessons learned regarding the management of patients as we endure this period of human history.
Collapse
Affiliation(s)
- James E Siegler
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ 08103, USA
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Savanna Dasgupta
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ 08103, USA
| | - Mohamad Abdalkader
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| | - Mary Penckofer
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA
| | - Shadi Yaghi
- Department of Neurology, Rhode Island Hospital, Brown University, Providence, RI 02912, USA
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
| |
Collapse
|
9
|
Sioutas GS, Amllay A, Chen CJ, El Naamani K, Abbas R, Jain P, Garg A, Stine EA, Tjoumakaris SI, Herial NA, Gooch MR, Zarzour H, Schmidt RF, Rosenwasser RH, Jabbour P. The Impact of Weather and Mode of Transport on Outcomes of Patients With Acute Ischemic Stroke Undergoing Mechanical Thrombectomy. Neurosurgery 2023; 93:144-155. [PMID: 36757189 DOI: 10.1227/neu.0000000000002391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 12/06/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Efficient transfer to mechanical thrombectomy (MT)-capable centers is essential for patients with stroke. Weather may influence stroke risk, transportation, and outcomes. OBJECTIVE To investigate how weather affects stroke patient transfer and outcomes after MT. METHODS We retrospectively collected data for patients with stroke transferred from spoke to our hub hospital to undergo MT between 2017 and 2021. We examined associations between weather, transportation, and patient outcomes. RESULTS We included 543 patients with a mean age of 71.7 years. The median National Institutes of Health Stroke Score increased from 14 to 15 after transportation. The median modified Rankin Scale was 4 at discharge and 90 days, and 3 at the final follow-up (mean 91.7 days). Higher daily temperatures were associated with good outcome, whereas daily drizzle was associated with poor outcome. More patients were transferred by air when visibility was better, and by ground during heavier precipitation, higher humidity, rain, mist, and daily drizzle, fog, and thunder . Patient outcomes were not associated with transportation mode. Among the independent predictors of good outcome, none was a weather variable. Lower hourly relative humidity ( P = .003) and longer road distance ( P < .001) were independent predictors of using air transportation, among others. CONCLUSION During transportation, higher temperature was associated with good outcome, whereas daily drizzle was associated with poor outcome after MT. Although weather was associated with transportation mode, no differences in outcomes were found between transportation modes. Further studies are needed to modify transfer protocols, especially during cold and rainy days, and potentially improve outcomes.
Collapse
Affiliation(s)
- Georgios S Sioutas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abdelaziz Amllay
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
| | - Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Paarth Jain
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ananya Garg
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Emily A Stine
- Psychology Department, College of Arts and Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Stavropoula I Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - M Reid Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Richard F Schmidt
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
- Psychology Department, College of Arts and Sciences, Arcadia University, Glenside, Pennsylvania, USA
| |
Collapse
|
10
|
El Naamani K, Jabbour P. In Reply to the Letter to the Editor Regarding: "The Effect of COVID-19 Vaccines on Stroke Outcomes: A Single-Center Study". World Neurosurg 2023; 171:197. [PMID: 36869561 PMCID: PMC9970830 DOI: 10.1016/j.wneu.2022.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 03/05/2023]
Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Pascal Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
11
|
Pourciau P, Smith BC. Stroke Risk Related to Coronavirus Disease-2019: What Have We Learned? Crit Care Nurs Clin North Am 2023; 35:53-65. [PMID: 36774007 PMCID: PMC9584860 DOI: 10.1016/j.cnc.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Since the intial outbreak of the coronavirus-2019 (COVID-19) in December 2019, a variety of neurologic manifestations have been linked to this virus, including stroke. Comprehensive review of worldwide studies using various methodologies indicated a correlation of increased stroke risk in patients with COVID-19. The literature reivew also revealed increased morbidity and mortality among patients with COVID-19 and stroke as compared to those with only stroke. This pandemic, with its related healthcare staffing shortages, revealed the requisite to utilize innovative technologies such as Tele-Neurology, as well as public health campaigns focusing on stroke recognition and early treatment.
Collapse
Affiliation(s)
- Pamela Pourciau
- East Jefferson Neurological Associates, 3800 Houma Boulevard, Suite 325, Metairie, LA 70006, USA.
| | | |
Collapse
|
12
|
El Naamani K, Amllay A, Chen CJ, Capone S, Abbas R, Sioutas GS, Munoz A, Yudkoff CJ, Carreras A, Sambangi A, Hunt A, Jain P, Stine EA, Sathe A, Smit R, Yazbeck F, Tjoumakaris SI, Gooch MR, Herial NA, Rosenwasser RH, Zarzour H, Schmidt RF, El-Ghanem M, Jabbour PM. The Effect of COVID-19 Vaccines on Stroke Outcomes: A Single-Center Study. World Neurosurg 2023; 170:e834-e839. [PMID: 36494068 PMCID: PMC9726206 DOI: 10.1016/j.wneu.2022.11.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND One of the defining narratives of the COVID-19 pandemic has been the acceptance and distribution of vaccine. To compare the outcomes of COVID-19 positive vaccinated and unvaccinated stroke patients. METHODS This is a single-center retrospective study of COVID-19-vaccinated and unvaccinated stroke patients between April 2020 and March 2022. All patients presenting with stroke regardless of treatment modalities were included. National Institutes of Health Stroke Scale was used to assess stroke severity. The primary outcome was functional capacity of the patients at discharge. RESULTS The study cohort comprised 203 COVID-19 positive stroke patients divided into 139 unvaccinated and 64 fully vaccinated patients. At discharge, the modified Rankin scale score was significantly lower in the vaccinated cohort (3[1-4] vs. 4[2-5], odds ratio = 0.508, P = 0.011). At 3 months of follow-up, the median modified Rankin scale score was comparable between both cohorts. CONCLUSIONS Although vaccination did not show any significant difference in stroke patient outcomes on follow-up, vaccines were associated with lower rates of morbidity and mortality at discharge among stroke patients during the pandemic.
Collapse
Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abdelaziz Amllay
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, Texas, USA
| | - Stephen Capone
- Department of Neurology, Virginia Tech Carilion Clinic, Roanoke, Virginia, USA
| | - Rawad Abbas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Alfredo Munoz
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Clifford J Yudkoff
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Angeleah Carreras
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Abhijeet Sambangi
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Adam Hunt
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Paarth Jain
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Emily A Stine
- Psychology Department, College of Arts and Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Anish Sathe
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rupert Smit
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Fouad Yazbeck
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Stavropoula I Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael R Gooch
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Nabeel A Herial
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Robert H Rosenwasser
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Hekmat Zarzour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Richard F Schmidt
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Mohammad El-Ghanem
- Department of Neurology, HCA-Houston, University of Houston, Houston, Texas, USA
| | - Pascal M Jabbour
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
13
|
Mowla A, Shakibajahromi B, Shahjouei S, Baharvahdat H, Harandi AA, Rahmani F, Mondello S, Rahimian N, Cernigliaro A, Hokmabadi ES, Ebrahimzadeh SA, Ramezani M, Mehrvar K, Farhoudi M, Naderi S, Fenderi SM, Pishjoo M, Alizada O, Purroy F, Requena M, Tsivgoulis G, Zand R. SARS-CoV-2 infection might be a predictor of mortality in intracerebral hemorrhage. J Neurol Sci 2023; 444:120497. [PMID: 36455388 PMCID: PMC9683865 DOI: 10.1016/j.jns.2022.120497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/10/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND SARS-CoV-2 infection may be associated with uncommon complications such as intracerebral hemorrhage (ICH), with a high mortality rate. We compared a series of hospitalized ICH cases infected with SARS-CoV-2 with a non-SARS-CoV-2 infected control group and evaluated if the SARS-CoV-2 infection is a predictor of mortality in ICH patients. METHODS In a multinational retrospective study, 63 cases of ICH in SARS-CoV-2 infected patients admitted to 13 tertiary centers from the beginning of the pandemic were collected. We compared the clinical and radiological characteristics and in-hospital mortality of these patients with a control group of non-SARS-CoV-2 infected ICH patients of a previous cohort from the country where the majority of cases were recruited. RESULTS Among 63 ICH patients with SARS-CoV-2 infection, 23 (36.5%) were women. Compared to the non-SARS-CoV-2 infected control group, in SARS-CoV-2 infected patients, ICH occurred at a younger age (61.4 ± 18.1 years versus 66.8 ± 16.2 years, P = 0.044). These patients had higher median ICH scores ([3 (IQR 2-4)] versus [2 (IQR 1-3)], P = 0.025), a more frequent history of diabetes (34% versus 16%, P = 0.007), and lower platelet counts (177.8 ± 77.8 × 109/L versus 240.5 ± 79.3 × 109/L, P < 0.001). The in-hospital mortality was not significantly different between cases and controls (65% versus 62%, P = 0.658) in univariate analysis; however, SARS-CoV-2 infection was significantly associated with in-hospital mortality (aOR = 4.3, 95% CI: 1.28-14.52) in multivariable analysis adjusting for potential confounders. CONCLUSION Infection with SARS-CoV-2 may be associated with increased odds of in-hospital mortality in ICH patients.
Collapse
Affiliation(s)
- Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, California, USA
| | | | - Shima Shahjouei
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA, USA
| | - Humain Baharvahdat
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Amini Harandi
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Rahmani
- Department of Emergency Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Nasrin Rahimian
- Department of Neurology, Tufts Medical Center, Boston, MA, USA
| | | | | | - Seyed Amir Ebrahimzadeh
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mahtab Ramezani
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Mehrvar
- Department of Neurology, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Mehdi Farhoudi
- Neurosciences Resarch Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Soheil Naderi
- Neurosurgery Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Mahmoudnejad Fenderi
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoud Pishjoo
- Division of Neuroendovascular Surgery, Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Orkhan Alizada
- Department of Neurosurgery, Baskent University, Faculty of Medicine, Istanbul, Turkey
| | - Francisco Purroy
- Department of Neurology, Hospital Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLLeida), Universitat de Lleida UdL Lleida, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Department de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Ramin Zand
- Neurology Department, Neuroscience Institute, Geisinger Health System, PA, USA.
| |
Collapse
|
14
|
Mechanical Thrombectomy in Acute Ischemic Stroke COVID-19 and Non-COVID-19 Patients: A Single Comprehensive Stroke Center Study. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010186. [PMID: 36676134 PMCID: PMC9866657 DOI: 10.3390/life13010186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/01/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Abstract
Coronavirus disease 2019 (COVID-19) increases the risk for thromboembolic events, such as acute ischemic stroke (AIS). Mechanical thrombectomy (MT) is a therapy of choice in early diagnosed AIS; however, its success and outcomes in COVID-19 patients are contradictory. This study presented our experience with MT performed in COVID-19 patients compared to a control group. The retrospective analysis included patients with AIS who underwent MT from April 2021 to April 2022 at our institution. There were 13 COVID-19-related patients (with active or past COVID-19 infection) and 55 non-COVID-19 patients (negative COVID-19 status). We analyzed patients' baseline clinical and laboratory data, modified Thrombolysis in Cerebral Infarction (mTICI) scale, used 24 h follow-up CT findings, and modified the Rankin scale. The COVID-19 group had higher values of leukocytes, neutrophils, neutrophil/leukocyte ratios, ASL, ALT, LDH and CRP, and lower values of lymphocytes compared to the control group. The AIS mostly occurred in posterior circulation in the COVID-19 group, while anterior circulation was more affected in the control group. Treatment approach and successful reperfusion did not differ between groups. In conclusion, although differences in some clinical and laboratory parameters between COVID-19 and non-COVID-19 groups were found, the outcomes of mechanical thrombectomy were equal.
Collapse
|
15
|
Wang L. Letter: Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study. Neurosurgery 2022; 91:e113-e114. [PMID: 35916594 DOI: 10.1227/neu.0000000000002102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Lesheng Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
16
|
El Naamani K, Jabbour P. In Reply: Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study. Neurosurgery 2022; 91:e115-e116. [PMID: 35916580 DOI: 10.1227/neu.0000000000002103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Kareem El Naamani
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
17
|
Thavarajah S, Langston Z, Sarayusa A, Fowler LA, Sivakumar S, Shah N. Evaluation of the Rapid Arterial oCclusion Evaluation (RACE) scale in Upstate South Carolina, USA. J Stroke Cerebrovasc Dis 2022; 31:106746. [PMID: 36087375 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/21/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Several stroke assessments have been designed for Emergency Medical Services to identify stroke patients with large vessel occlusion in the prehospital setting. The Rapid Arterial oCclusion Evaluation scale was developed in Spain, yet only few United States-based studies have confirmed findings from Spain. This study was designed to determine if the Rapid Arterial oCclusion Evaluation scale is a valid prehospital stroke assessment for identifying large vessel occlusion patients in South Carolina, USA. MATERIALS AND METHODS The performance of the Rapid Arterial oCclusion Evaluation scale was determined by calculating the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy at each score. The discriminative power of the Rapid Arterial oCclusion Evaluation score was evaluated using receiver operator characteristics. Comparison of the Rapid Arterial oCclusion Evaluation Scale to the National Institute of Health Stroke Scale was assessed using the Spearman's coefficient. RESULTS The Rapid Arterial oCclusion Evaluation scale had an acceptable discriminative power (c = 0.71). A score of ≥5 had a sensitivity of 0.71, specificity of 0.65, positive predictive value of 0.24, negative predictive value of 0.93, and accuracy of 0.66. There was a significant correlation between the Rapid Arterial Cclusion Evaluation score and the National Institute of Health Stroke Scale (rho = 0.60). CONCLUSION The Rapid Arterial oCclusion Evaluation scale performed comparably to the National Institute of Health Stroke Scale in South Carolina; however, performed lower than Spain. Future studies should investigate patient demographics and emergency medical services training to determine if these variables contribute to the results found in this study.
Collapse
Affiliation(s)
| | | | - Adam Sarayusa
- Prisma Health-Upstate, 701 Grove Rd, Greenville, SC 29605, USA
| | - Lauren A Fowler
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Sanjeev Sivakumar
- Prisma Health-Upstate, 701 Grove Rd, Greenville, SC 29605, USA; University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| | - Neel Shah
- Prisma Health-Upstate, 701 Grove Rd, Greenville, SC 29605, USA; University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC 29605, USA
| |
Collapse
|
18
|
Wang Z, Teng H, Wu X, Yang X, Qiu Y, Chen H, Chen Z, Wang Z, Chen G. Efficacy and safety of recanalization therapy for acute ischemic stroke with COVID-19: A systematic review and meta-analysis. Front Neurol 2022; 13:984135. [PMID: 36110391 PMCID: PMC9468325 DOI: 10.3389/fneur.2022.984135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe novel coronavirus disease 2019 (COVID-19) has rapidly spread worldwide and created a tremendous threat to global health. Growing evidence suggests that patients with COVID-19 have more severe acute ischemic stroke (AIS). However, the overall efficacy and safety of recanalization therapy for AIS patients infected by the SARS-CoV-2 virus is unknown.MethodsThe PRISMA guideline 2020 was followed. Two independent investigators systematically searched databases and ClinicalTrials.gov to identify relevant studies published up to 31 March 2022. AIS patients who received any recanalization treatments were categorized into those with COVID-19 and those without COVID-19. The main efficacy outcomes were patients' functional independence on discharge and successful recanalization, and the safety outcomes were in-hospital mortality and symptomatic intracranial hemorrhage. Subgroup analyses were implemented to assess the influence of admission National Institutes of Health Stroke Scale and different recanalization treatments on the outcomes. STATA software 12.0 was used for the statistical analysis.ResultsThis systematic review and meta-analysis identified 10 studies with 7,042 patients, including 596 COVID-19 positive patients and 6,446 COVID-19 negative patients. Of the total patients, 2,414 received intravenous thrombolysis while 4,628 underwent endovascular thrombectomy. COVID-19 positive patients had significantly lower rates of functional independence at discharge [odds ratio (OR) 0.30, 95% confidence interval (CI) 0.15 to 0.59, P = 0.001], lower rates of successful recanalization (OR 0.40, 95% CI 0.24 to 0.68, P = 0.001), longer length of hospital stay (weighted mean difference 5.09, 95% CI 1.25 to 8.94, P = 0.009) and higher mortality rates (OR 3.38, 95% CI 2.43 to 4.70, P < 0.0001). Patients with COVID-19 had a higher risk of symptomatic intracranial hemorrhage than the control group, although the difference did not reach statistical significance (OR 2.34, 95% CI 0.99 to 5.54, P = 0.053).ConclusionsCompared with COVID-19 negative AIS patients who received recanalization treatments, COVID-19 positive patients turned out to have poorer outcomes. Particular attention needs to be paid to the treatments for these COVID-19 patients to decrease mortality and morbidity. Long-term follow-up is necessary to evaluate the recanalization treatments for AIS patients with COVID-19.Systematic review registrationhttps://inplasy.com/inplasy-2022-4-0022/, identifier: INPLASY202240022.
Collapse
Affiliation(s)
- Zilan Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiying Teng
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Xiaoxiao Wu
- Suzhou Medical College of Soochow University, Suzhou, China
| | - Xingyu Yang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Youjia Qiu
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huiru Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhouqing Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Zhouqing Chen
| | - Zhong Wang
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
- Zhong Wang
| | - Gang Chen
- Department of Neurosurgery and Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
19
|
Kolahchi Z, Khanmirzaei M, Mowla A. Acute ischemic stroke and vaccine-induced immune thrombotic thrombocytopenia post COVID-19 vaccination; a systematic review. J Neurol Sci 2022; 439:120327. [PMID: 35752132 PMCID: PMC9212261 DOI: 10.1016/j.jns.2022.120327] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION One of the rare but potentially serious side effects of COVID-19 vaccination is arterial and venous thrombosis. Acute ischemic stroke (AIS) cases have been reported post COVID-19 vaccination. Herein, we systematically reviewed the reported cases of AIS after COVID-19 vaccination. METHOD This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We searched PubMed and Scopus until April 14, 2022 to find studies that reported AIS post COVID-19 vaccination. RESULTS We found 447 articles. From those, 140 duplicates were removed. After screening and excluding irrelevant articles, 29 studies (43 patients) were identified to be included. From all cases, 22 patients (51.1%) were diagnosed with AIS associated with Vaccine-induced immune thrombotic thrombocytopenia (VITT). Among AIS associated with VITT group, all received viral vector vaccines except one. The majority of cases with AIS and VITT were female (17 cases, 77.2%) and aged below 60 years (15 cases, 68%). Fourteen patients (32.5%) had additional thrombosis in other sites. Four of them (0.09%) showed concurrent CVST and ischemic stroke. Hemorrhagic transformation following AIS occurred in 7 patients (16.27%). Among 43 patients with AIS, at least 6 patients (14%) died during hospital admission. CONCLUSION AIS has been reported as a rare complication within 4 weeks post COVID-19 vaccination, particularly with viral vector vaccines. Health care providers should be familiar with this rare consequence of COVID-19 vaccination in particular in the context of VITT to make a timely diagnosis and appropriate treatment plan.
Collapse
Affiliation(s)
| | | | - Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, CA, USA.
| |
Collapse
|