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Marto JP, Strambo D, Ntaios G, Nguyen TN, Herzig R, Czlonkowska A, Demeestere J, Mansour OY, Salerno A, Wegener S, Baumgartner P, Cereda CW, Bianco G, Beyeler M, Arnold M, Carrera E, Machi P, Altersberger V, Bonati L, Gensicke H, Bolognese M, Peters N, Wetzel S, Magriço M, Ramos JN, Sargento-Freitas J, Machado R, Maia C, Machado E, Nunes AP, Ferreira P, Pinho e Melo T, Dias MC, Paula A, Correia MA, Castro P, Azevedo E, Albuquerque L, Alves JN, Ferreira-Pinto J, Meira T, Pereira L, Rodrigues M, Araujo AP, Rodrigues M, Rocha M, Pereira-Fonseca Â, Ribeiro L, Varela R, Malheiro S, Cappellari M, Zivelonghi C, Sajeva G, Zini A, Gentile M, Forlivesi S, Migliaccio L, Sessa M, La Gioia S, Pezzini A, Sangalli D, Zedde M, Pascarella R, Ferrarese C, Beretta S, Diamanti S, Schwarz G, Frisullo G, Marcheselli S, Seners P, Sabben C, Escalard S, Piotin M, Maïer B, Charbonnier G, Vuillier F, Legris L, Cuisenier P, Vodret FR, Marnat G, Liegey JS, Sibon I, Flottmann F, Broocks G, Gloyer NO, Bohmann FO, Schaefer JH, Nolte C, Audebert HJ, Siebert E, Sykora M, Lang W, Ferrari J, Mayer-Suess L, Knoflach M, Gizewski ER, Stolp J, Stolze LJ, Coutinho JM, Nederkoorn P, van den Wijngaard I, De Meris J, Lemmens R, De Raedt S, Vandervorst F, Rutgers MP, Guilmot A, Dusart A, Bellante F, Calleja-Castaño P, Ostos F, González-Ortega G, Martín-Jiménez P, García-Madrona S, Cruz-Culebras A, Vera R, Matute MC, Fuentes B, Alonso-de-Leciñana M, Rigual R, Díez-Tejedor E, Perez-Sanchez S, Montaner J, Díaz-Otero F, Pérez-de-la-Ossa N, Flores-Pina B, Muñoz-Narbona L, Chamorro A, Rodríguez-Vázquez A, Renú A, Ayo-Martin O, Hernández-Fernández F, Segura T, Tejada-Meza H, Sagarra-Mur D, Serrano-Ponz M, Hlaing T, See I, Simister R, Werring D, Kristoffersen ES, Nordanstig A, Jood K, Rentzos A, Šimůnek L, Krajíčková D, Krajina A, Mikulik R, Cviková M, Vinklárek J, Školoudík D, Roubec M, Hurtikova E, Hrubý R, Ostry S, Skoda O, Pernicka M, Jurak L, Eichlová Z, Jíra M, Kovar M, Panský M, Mencl P, Palouskova H, Tomek A, Janský P, Olšerová A, Sramek M, Havlicek R, Malý P, Trakal L, Fiksa J, Slovák M, Karlinski MA, Nowak M, Sienkiewicz-Jarosz H, Bochynska A, Wrona P, Homa T, Sawczynska K, Slowik A, Wlodarczyk E, Wiacek M, Tomaszewska-Lampart I, Sieczkowski B, Bartosik-Psujek H, Bilik M, Bandzarewicz A, Dorobek M, Zielinska-Turek J, Nowakowska-Kotas M, Obara K, Urbanowski P, Budrewicz S, Guziński M, Świtońska M, Rutkowska I, Sobieszak-Skura P, Labuz-Roszak BM, Debiec A, Staszewski J, Stępień A, Zwiernik J, Wasilewski G, Tiu C, Terecoasă EO, Radu RA, Negrila A, Dorobat B, Panea C, Tiu V, Petrescu S, Ozdemir A, Mahmoud M, El-Samahy H, Abdelkhalek H, Al-Hashel J, Ismail II, Salmeen A, Ghoreishi A, Sabetay SI, Gross H, Klein P, Abdalkader M, Jabbour P, El Naamani K, Tjoumakaris S, Abbas R, Mohamed GA, Chebl A, Min J, Hovingh M, Tsai JP, Khan M, Nalleballe K, Onteddu S, Masoud H, Michael M, Kaur N, Maali L, Abraham MG, Khandelwal P, Bach I, Ong M, Babici D, Khawaja AM, Hakemi M, Rajamani K, Cano-Nigenda V, Arauz A, Amaya P, Llanos N, Arango A, Vences MÁ, Barrientos Guerra JD, Caetano R, Martins RT, Scollo SD, Yalung PM, Nagendra S, Gaikwad A, Seo KD, Georgiopoulos G, Nogueira RG, Michel P. Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry. Neurology 2023; 100:e739-e750. [PMID: 36351814 PMCID: PMC9969910 DOI: 10.1212/wnl.0000000000201537] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/23/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES COVID-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. METHODS This 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). RESULTS Of 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). DISCUSSION Patients 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. TRIAL REGISTRATION INFORMATION The study was registered under ClinicalTrials.gov identifier NCT04895462.
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Affiliation(s)
- João Pedro Marto
- Department of Neurology (J.P.M., M.M.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Stroke Centre (D.S., A.S., P.M.), Neurology Service, Department of Neurological Sciences, Lausanne University Hospital, Switzerland; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology, Radiology (T.N.N.), Boston Medical Center, Boston University School of Medicine, MA; Department of Neurology (R.H., L.S., D.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; 2nd Department of Neurology (A.C., M.A.K., M.N.), Institute of Psychiatry and Neurology, Warsaw, Poland; Neurology Department (J.D., R.L.), Leuven University Hospital, Belgium; Alexandria University Hospitals and Affiliated Stroke Network (O.Y.M.), Egypt; Department of Neurology (S.W., P.B.), University Hospital of Zurich, Switzerland; Stroke Center (C.W.C., G.B.), Neurocenter of Southern Switzerland, EOC, Lugano; Stroke Center (M.B, M.A.), Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Switzerland; Stroke Centre (E.C.), Geneva University Hospital, Switzerland; Department of Neuroradiology (P.M.), Geneva University Hospital, Switzerland; Stroke Centre (V.A, L.B., H.G.), University Hospital Basel and University of Basel, Switzerland; Stroke Centre (M.B.), Kantonsspital Lucerne, Switzerland; Stroke Centre (N.P., S.W.), Hirslanden Hospital, Zurich, Switzerland; Department of Neuroradiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Department of Neurology (J.S.-F., R.M., C.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Department of Neuroradiology (E.M.), Centro Hospitalar Universitário de Coimbra, Portugal; Stroke Unit (A.P.N., P.F.), Hospital de São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Stroke Unit (T.P.e.M., M.C.D., A.P.), Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neuroradiology (M.A.C.), Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Department of Neurology (P.C., E.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Department of Neuroradiology (L.A.), Centro Hospitalar Universitário São João, Porto, Portugal; Departments of Neurology (J.N.A., J.F.-P.), and Neuroradiology (T.M.), Hospital de Braga, Portugal; Department of Neurology (L.P., M.R.), Hospital Garcia de Orta, Almada, Portugal; Department of Neuroradiology (A.P.A., M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (M.R.), Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal; Department of Neurology (A.P.-F, L.R.), Unidade Local de Saúde de Matosinhos, Portugal; Department of Neurology (R.V., S.M.), Centro Hospitalar Universitário do Porto, Portugal; Stroke Unit (M.C., C.Z.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna (A.Z., M.G., S.F., L.M.), Department of Neurology and Stroke Centre, Maggiore Hospital, Bologna, Italy; Department of Neurology (M.S., S.L.G.), ASST Papa Giovanni XXIII, Bergamo, Italy; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, University of Brescia, Italy; Department of Neurology and Stroke Unit (D.S.), Azienda Socio Sanitaria Territoriale, Lecco, Italy; Neurology Unit (M.Z.), Stroke Unit, Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Neuroradiology Unit (R.P.), Azienda Unità Sanitaria-IRCCS di Reggio Emilia, Italy; Department of Neurology (C.F., S.B., S.D.), San Gerardo Hospital, Department of Medicine and Surgery and Milan Centre for Neuroscience, University of Milano Bicocca, Monza, Italy; Stroke Unit (G.S.), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Neurology (G.F.), Policlinico Universitario Agostino Gemelli, Rome, Italy; Emergency Neurology and Stroke Unit (S.M.), IRCCS Humanitas Clinical and Research Center, Rozzano, Italy; Department of Neurology (C.S., S.E.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (M.P., B.M.), Hôpital Fondation Ade Rothschild, Paris, France; Department of Interventional Neuroradiology (G.C., F.V.), Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, Besançon, France; Neurology (F.L., P.C, F.R.V.), Stroke Unit, Centre Hospitalier Universitaire, Grenoble Alpes, France; Department of Interventional and Diagnostic Neuroradiology (J.-S.L., I.S.), Bordeaux University Hospital, France; Department of Diagnostic and Interventional Neuroradiology (F.F, G.B., N.-O.G.), University Medical Center-Hamburg-Eppendorf, Germany; Department of Neurology (F.O.B., J.H.S.), University Hospital Frankfurt, Goethe University, Germany; Department of Neurology and Centre for Stroke Research (H.J.A.), Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Germany; Department of Neuroradiology (E.S.), Charité-Universitätsmedizin Berlin, Germany; Department of Neurology (M.S, W.L., J.F.), St. John's Hospital, Vienna, Austria; Departments of Neurology (L.M.-S., M.K.), and Neuroradiology (E.R.G.), Medical University of Innsbruck, Austria; Department of Neurology (J.S., L.J.S., J.M.C.), Amsterdam University Medical Centers, Netherlands; Department of Neurology (I.v.d.W., J.d.M.), Haaglanden Medical Centre, Hague and Department of Radiology, Leiden University Medical Centre, Netherlands; Department of Neurology (S.D.R., F.V.), Universitair Ziekenhuis Brussel, Centre for Neurosciences, Vrije Universiteit Brussel, Belgium; Department of Neurology (M.P.R, A.G.), Stroke Unit, Europe Hospitals, Brussels, Belgium; Department of Neurology (A.D., F.B.), Centre Hospitalier Universitaire de Charleroi, Belgium; Department of Neurology and Stroke Centre (P.C.-C., F.O., P.M.-J.), Hospital Universitario de OctubreInstituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Department of Neurology and Stroke Centre (A.C.-C., R.V., M.C.M.), Hospital Universitario Ramón y Cajal, Ramon y Cajal Institute for Health Research (IRYCIS), Madrid, Spain; Department of Neurology and Stroke (B.F, M.A.d.L., R.R., E.D.D.), Centre Hospital La Paz Institute for Health Research-IdiPAZ (La Paz University Hospital-Universidad Autónoma de Madrid), Spain; Department of Neurology (S.P.-S., J.M.), Hospital Universitario Virgen Macarena, Seville, Spain; Stroke Centre (F.D-.O.), Hospital General Universitario Gregorio Marañón, Madrid, Spain; Stroke Unit (B.F.-P., J.M.-N.), Germans Trias Hospital, Barcelona, Spain; Department of Neurology (A.C, A.R.-V., A.R), Comprehensive Stroke Centre, Hospital Clinic from Barcelona, Spain; Department of Neurology (O.A.-M, F.H.-F.), Complejo Hospitalario Universitario de Albacete; Stroke Unit (H.T.-M.), Department of Neurology, and Interventional Neuroradiology Unit, Hospital Universitario Miguel Servet, Spain; Stroke Unit (D.S.-M, M.F.P.), Department of Neurology, Hospital Universitario Miguel Servet, Spain; Stroke and Geriatric Medicine (T.H.), Aintree University Hospital, United Kingdom; Comprehensive Stroke Service (I.S., R.S.), University College London Hospitals NHS Foundation Trust and Stroke Research Centre, University College London, United Kingdom.; University College London (D.W.), Queen Square Institute of Neurology, London, United Kingdom; Department of Neurology (E.S.K.), Akershus University Hospital, Lørenskog and Department of General Practice, University of Oslo, Norway; Department of Clinical Neuroscience (A.N, K.J.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg and Department of Neurology (A.N, K.J.), Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.R.), Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg and Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology (A.K.), Comprehensive Stroke Centre, Charles University Faculty of Medicine and University Hospital, Hradec Králové, Czech Republic; International Clinical Research Centre (R.M., M.C., J.V.) and Department of Neurology, St. Anne´s University Hospital and Faculty of Medicine at Masaryk University, Brno, Czech Republic; Center for Health Research (D.S., M.R, E.H.), Faculty of Medicine, University of Ostrava, Czech Republic; Department of Neurology (R.H, S.V.), České Budějovice Hospital, Czech Republic; Department of Neurology (O.S., M.P.), Jihlava Hospital, Czech Republic; Neurocenter (L.J., Z.E., M.J.), Regional Hospital Liberec, Czech Republic; Cerebrovascular Centre (M.K., M.P., P.M.), Na Homolce Hospital, Prague, Czech Republic; Department of Neurology (H.P.), Karviná Miners Hospital Inc., Czech Republic; Cerebrovascular Centre (A.T, P.J, A.O.), University Hospital in Motol, Prague, Czech Republic; Cerebrovascular Centre (M.S., R.H, P.M., L.T.), Central Military Hospital, Prague, Czech Republic; Cerebrovascular Centre (J.F., M.S.), General University Hospital, Prague, Czech Republic; 1th Department of Neurology (H.S.-J, A.B.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Neurology (P.W, T.H., K.S., A.S), University Hospital, Jagiellonian University, Cracow, Poland; Department of Neurology (M.W., L.T.-L., B.S.), Institute of Medical Sciences, Medical College of Rzeszow University, Poland; Department of Neurology and Stroke (M.B, A.B.), St. John Paul II Western Hospital, Grodzisk Mazowiecki, Poland; Department of Neurology (M.D, J.Z.), Central Clinical Hospital of the Ministry of the Interior and Administration, Warsaw, Poland; Departments of Neurology (M.N.-K., K.O., P.U.), and Radiology (M.G.), Wroclaw Medical University, Poland; Department of Neurosurgery and Neurology (M.S.), Nicolaus Copernicus University in Torun Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland; Stroke Intervention Centre (I.R., P.S.-S.), Department of Neurosurgery and Neurology, Jan Biziel University Hospital, Bydgoszcz, Poland; Department of Neurology (B.M.L.-R.), Institute of Medical Sciences, University of Opole, Poland; Clinic of Neurology (A.D., J.S., A.S.), Military Institute of Medicine, Warsaw, Poland; Department of Neurology (J.Z.), University of Warmia and Mazury, Olsztyn, Poland; Department of Radiology (C.W.), Provincial Specialist Hospital, Olsztyn, Poland; Department of Neurology (C.T., E.O.T., R.A.R., A.N.), University Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", Romania; Department of Radiology (B.D.), University Emergency Hospital Bucharest, Romania; Department of Neurology and Stroke Unit (C.P, V.T, S.P.), Elias University Emergency Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Neurology (A.O.), Eskisehir Osmangazi University, Turkey; Ain Shams University Affiliated Saudi German Hospital (M.M., H.E.-S.), Egypt; Neuropsychiatry Department (H.A.), Tanta University, Egypt; Department of Neurology (J.A.-H.), Ibn Sina Hospital, Kuwait; Department of Neurology (I.I.I.), Jaber Al-Ahmad Hospital, Kuwait; Department of Neurology (A.G.), School of Medicine, Zanjan University of Medical Sciences, Iran; Stroke Unit (S.I.S.), Neurology Department, Hillel Yaffe Medical Center, Hadera, Israel; Department of Neurosurgery (P.J., K.E.N, S.T., R.A.), Thomas Jefferson University Hospital, PA; Departments of Radiology (G.A.M., P.G.N.), Neurology and Neurosurgery, Grady Memorial Hospital, Atlanta, GA; Department of Neurology (A.C.), Henry Ford Hospital, Detroit, MI; Comprehensive Stroke Centre and Department of Neurosciences (J.M., M.H., M.K.), Spectrum Health and Michigan State University; Department of Neurology (K.N., S.O.), University of Arkansas for Medical Sciences, Little Rock, AR; Department of Neurology (M.K.), Upstate University Hospital, NY; Department of Neurology (L.M., M.G.A.), University of Kansas Medical Centre; Endovascular Neurological Surgery and Neurology (P.K., I.B, M.O., M.B.), Rutgers, The State University of New Jersey, Newark; Department of Neurology (A.M.K.), Wayne State University, Detroit Medical Center, MI; Stroke Clinic (V.C.-N, A.A.), Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico; Department of Neurology (P.A.), Fundación Valle del Lili, Cali, Colombia; Centro de Investigaciones Clínicas (N.L., A.A.), Fundación Valle del Lili, Cali, Colombia; Department of Neurology (M.A.V.), Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Péru; Hospital General San Juan de Dios (J.D.B.G.), Guatemala; Department of Neurology (R.C., R.T.M.), Hospital Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil; Ramos Mejía Hospital (S.D.S.), Stroke Unit, Buenos Aires, Argentina; St. Luke's Medical Center (P.M.Y.), Global City, Philippines; Department of Neurology (S.N., A.G.), Grant Medical College and Sir JJ Hospital, Mumbai, India; Department of Neurology (K.-D.S.), National Health Insurance Service Ilsan Hospital, Goyang, Korea; School of Biomedical Engineering and Imaging Sciences (G.G.), St Thomas Hospital, King's College London, UK; Department of Clinical Therapeutics (G.G.), National and Kapodistrian University of Athens, Greece.
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