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

2022; Lippincott Williams & Wilkins; Volume: 100; Issue: 7 Linguagem: Inglês

10.1212/wnl.0000000000201537

1526-632X

João Pedro Marto, Davide Strambo, George Ntaios, Thanh N. Nguyen, Roman Herzig, Anna Członkowska, Jelle Demeestere, Malek Mansour, Alexander Salerno, Susanne Wegener, Philipp Baumgartner, Carlo W. Cereda, Giovanni Bianco, Morin Beyeler, Marcel Arnold, Emmanuel Carrera, Paolo Machi, Valerian Altersberger, Leo H. Bonati, Henrik Gensicke, Manuel Bolognese, Nils Peters, Stephan G. Wetzel, Marta Magriço, João Nuno Ramos, João Sargento‐Freitas, Rita Sá Machado, Carolina Maia, Egídio Machado, Ana Paiva Nunes, Patrícia Ferreira, Teresa Pinho e Melo, Mariana Carvalho Dias, André Paula, Manuel Alberto Correia, Pedro Castro, Elsa Azevedo, Luís Albuquerque, José Matías Alves, Joana Ferreira-Pinto, Torcato Meira, Liliana Pereira, Miguel Rodrigues, André Araújo, Marta Rodrigues, Mariana Rocha, Ângelo Fonseca, Luís Ribeiro, Ricardo Varela, Sofia Malheiro, Manuel Cappellari, Cecilia Zivelonghi, Giulia Sajeva, Andrea Zini, Mauro Gentile, Stefano Forlivesi, Ludovica Migliaccio, Maria Sessa, Sara La Gioia, Alessandro Pezzini, Davide Sangalli, Marialuisa Zedde, Rosario Pascarella, Carlo Ferrarese, Simone Beretta, Susanna Diamanti, Ghil Schwarz, Giovanni Frisullo, Simona Marcheselli, Pierre Seners, Candice Sabben, Simon Escalard, Michel Piotin, Benjamin Maïer, Guillaume Charbonnier, Fabrice Vuillier, Loïc Legris, Pauline Cuisenier, Francesca R. Vodret, Gaultier Marnat, Jean‐Sebastien Liegey, Igor Sibon, Fabian Flottmann, Gabriel Broocks, Nils-Ole Gloyer, Ferdinand O. Bohmann, Jan Hendrik Schaefer, Christian H. Nolte, Heinrich J. Audebert, Eberhard Siebert, M. Sýkora, Wilfried Lang, Julia Ferrari, Lukas Mayer‐Suess, Michael Knoflach, Elke R. Gizewski, Jeffrey Stolp, Lotte J. Stolze, Jonathan M. Coutinho, Paul J. Nederkoorn, Ido R. van den Wijngaard, Joke De Meris, Robin Lemmens, Sylvie De Raedt, Fenne Vandervorst, Matthieu Pierre Rutgers, Antoine Guilmot, Anne Dusart, Flavio Bellante, Patricia Calleja‐Castaño, Fernando Ostos, Guillermo González‐Ortega, Paloma Martín‐Jiménez, Sebastián García‐Madrona, Antonio Culebras, Rocío Vera, María Consuelo Matute, Blanca Fuentes, María Alonso de Leciñana, Ricardo Rigual, Exuperio Díez‐Tejedor, Soledad Pérez-Sánchez, Joan Montaner, Fernando Díaz‐Otero, Natalia Pérez-de-la-Ossa, Belén Flores-Pina, Lucía Campos Muñoz, Ángel Chamorro, Alejandro Rodríguez-Vázquez, Arturo Renú, Óscar Ayo‐Martín, Francisco Hernández‐Fernández, Tomás Segura, H. Tejada Meza, Daniel Sagarra-Mur, M Serrano-Ponz, Thant Hlaing, Isaiah See, Robert Simister, David J. Werring, Espen Saxhaug Kristoffersen, Annika Nordanstig, Katarina Jood, Alexandros Rentzos, Libor Šimůnek, Dagmar Krajíčková, Antonı́n Krajina, Robert Mikulík, Martina Cviková, Jan Vinklárek, David Školoudík, Martin Roubec, Eva Hurtíková, Rostislav Hrubý, Svatopluk Ostrý, Ondřej Škoda, Marek Pernicka, Lubomír Jurák, Zuzana Eichlová, Martin Jíra, Martin Kovář, Michal Panský, Pavel Mencl, Hana Paloušková, Aleš Tomek, Petr Janský, Anna Olšerová, Martin Šrámek, Roman Havlíček, Petr Malý, Lukáš Trakal, Jan Fiksa, Matěj Slovák, Michał Karliński, Maciej Nowak, Halina Sienkiewicz‐Jarosz, Anna Bochyńska, Paweł Wrona, Tomasz Homa, Katarzyna Sawczyńska, Agnieszka Słowik, Ewa Włodarczyk, Marcin Wiącek, Izabella Tomaszewska-Lampart, Bartosz Sieczkowski, Halina Bartosik-Psujek, Marta Bilik, Anna Bandzarewicz, Małgorzata Dorobek, Justyna Zielińska-Turek, Marta Nowakowska‐Kotas, Krystian Obara, Paweł Urbanowski, Sławomir Budrewićz, Maciej Guziński, Milena Świtońska, Iwona A. Rutkowska, Paulina Sobieszak-Skura, Beata Łabuz-Roszak, Aleksander Dębiec, Jacek Staszewski, Adam Stępień, Jacek Zwiernik, Grzegorz Wasilewski, Cristina Tiu, Elena Terecoasa, Răzvan Alexandru Radu, Anca Negrilă, Bogdan Dorobăț, Cristina Panea, Vlad Eugen Tiu, Simona Petrescu, Atilla Ozdemir, Mostafa Mahmoud, Hussam El-Samahy, Hazem Abdelkhalek, Jasem Al–Hashel, Ismail Ibrahim Ismail, Athari Salmeen, Abdoreza Ghoreishi, Sergiu Sabetay, Hana Gross, Piers Klein, Mohamad Abdalkader, Pascal Jabbour, Kareem El Naamani, Stavropoula Tjoumakaris, Rawad Abbas, Ghada Mohamed, Alex Chebl, Jiangyong Min, Majesta Hovingh, Jenney P. Tsai, Muhib Khan, Krishna Nalleballe, Sanjeeva Onteddu, Hesham Masoud, Mina Michael, Navreet Kaur, Laith Maali, Michael Abraham, Priyank Khandelwal, Ivo Bach, Melody Ong, Denis Babici, Ayaz Khawaja, Maryam Hakemi, Kumar Rajamani, Vanessa Cano-Nigenda, Antonio Araúz, Pablo Amaya, Natalia Llanos, Akemi Arango, Miguel A. Vences, Jose Dominguo Barrientos Guerra, Rayllene Caetano, Rodrigo Targa Martins, Sergio Scollo, Patrick Matic Yalung, Shashank Nagendra, Abhijit Gaikwad, Kwon‐Duk Seo, Georgios Georgiopoulos, Raul G Nogueira, Patrik Michel,

COVID-19 and healthcare impacts

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.