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

Global COVID-19 Stroke Registry

doi:10.1212/WNL.0000000000201537

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

Global COVID-19 Stroke Registry

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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.

Original language	English
Pages (from-to)	739-750
Number of pages	12
Journal	Neurology
Volume	100
Issue number	7
DOIs	https://doi.org/10.1212/WNL.0000000000201537
Publication status	Published - 14 Feb 2023

Keywords

Humans
Ischemic Stroke/epidemiology
Fibrinolytic Agents/therapeutic use
Brain Ischemia/complications
Cohort Studies
Thrombolytic Therapy/adverse effects
Treatment Outcome
COVID-19/complications
Stroke/epidemiology
Intracranial Hemorrhages/etiology
Cerebral Hemorrhage/complications
Endovascular Procedures/adverse effects
Registries

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@article{b3338a51555c422bb130968994bad2f0,

title = "Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry",

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.",

keywords = "Humans, Ischemic Stroke/epidemiology, Fibrinolytic Agents/therapeutic use, Brain Ischemia/complications, Cohort Studies, Thrombolytic Therapy/adverse effects, Treatment Outcome, COVID-19/complications, Stroke/epidemiology, Intracranial Hemorrhages/etiology, Cerebral Hemorrhage/complications, Endovascular Procedures/adverse effects, Registries",

author = "{Global COVID-19 Stroke Registry} and Marto, {Jo{\~a}o Pedro} and Davide Strambo and George Ntaios and Nguyen, {Thanh N} and Roman Herzig and Anna Czlonkowska and Jelle Demeestere and Mansour, {Ossama Yassin} and Alexander Salerno and Susanne Wegener and Philipp Baumgartner and Cereda, {Carlo W} and Giovanni Bianco and Morin Beyeler and Marcel Arnold and Emmanuel Carrera and Paolo Machi and Valerian Altersberger and Leo Bonati and Henrik Gensicke and Manuel Bolognese and Nils Peters and Stephan Wetzel and Marta Magri{\c c}o and Ramos, {Jo{\~a}o Nuno} and Jo{\~a}o Sargento-Freitas and Rita Machado and Carolina Maia and Eg{\'i}dio Machado and Nunes, {Ana Paiva} and Patricia Ferreira and {Pinho E Melo}, Teresa and Dias, {Mariana Carvalho} and Andr{\'e} Paula and Correia, {Manuel Alberto} and Pedro Castro and Elsa Azevedo and Lu{\'i}s Albuquerque and Alves, {Jos{\'e} Nuno} and Joana Ferreira-Pinto and Torcato Meira and Liliana Pereira and Miguel Rodrigues and Araujo, {Andre Pinho} and Marta Rodrigues and Mariana Rocha and {\^A}ngelo Pereira-Fonseca and {De Raedt}, Sylvie and Fenne Vandervorst and Vences, {Miguel {\'A}ngel}",

note = "{\textcopyright} 2022 American Academy of Neurology.",

year = "2023",

month = feb,

day = "14",

doi = "10.1212/WNL.0000000000201537",

language = "English",

volume = "100",

pages = "739--750",

journal = "Neurology",

issn = "0028-3878",

publisher = "Lippincott Williams and Wilkins",

number = "7",

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TY - JOUR

T1 - Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19

T2 - The Global COVID-19 Stroke Registry

AU - Global COVID-19 Stroke Registry

AU - Marto, João Pedro

AU - Strambo, Davide

AU - Ntaios, George

AU - Nguyen, Thanh N

AU - Herzig, Roman

AU - Czlonkowska, Anna

AU - Demeestere, Jelle

AU - Mansour, Ossama Yassin

AU - Salerno, Alexander

AU - Wegener, Susanne

AU - Baumgartner, Philipp

AU - Cereda, Carlo W

AU - Bianco, Giovanni

AU - Beyeler, Morin

AU - Arnold, Marcel

AU - Carrera, Emmanuel

AU - Machi, Paolo

AU - Altersberger, Valerian

AU - Bonati, Leo

AU - Gensicke, Henrik

AU - Bolognese, Manuel

AU - Peters, Nils

AU - Wetzel, Stephan

AU - Magriço, Marta

AU - Ramos, João Nuno

AU - Sargento-Freitas, João

AU - Machado, Rita

AU - Maia, Carolina

AU - Machado, Egídio

AU - Nunes, Ana Paiva

AU - Ferreira, Patricia

AU - Pinho E Melo, Teresa

AU - Dias, Mariana Carvalho

AU - Paula, André

AU - Correia, Manuel Alberto

AU - Castro, Pedro

AU - Azevedo, Elsa

AU - Albuquerque, Luís

AU - Alves, José Nuno

AU - Ferreira-Pinto, Joana

AU - Meira, Torcato

AU - Pereira, Liliana

AU - Rodrigues, Miguel

AU - Araujo, Andre Pinho

AU - Rodrigues, Marta

AU - Rocha, Mariana

AU - Pereira-Fonseca, Ângelo

AU - De Raedt, Sylvie

AU - Vandervorst, Fenne

AU - Vences, Miguel Ángel

PY - 2023/2/14

Y1 - 2023/2/14

N2 - 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.

AB - 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.

KW - Humans

KW - Ischemic Stroke/epidemiology

KW - Fibrinolytic Agents/therapeutic use

KW - Brain Ischemia/complications

KW - Cohort Studies

KW - Thrombolytic Therapy/adverse effects

KW - Treatment Outcome

KW - COVID-19/complications

KW - Stroke/epidemiology

KW - Intracranial Hemorrhages/etiology

KW - Cerebral Hemorrhage/complications

KW - Endovascular Procedures/adverse effects

KW - Registries

UR - http://www.scopus.com/inward/record.url?scp=85149298744&partnerID=8YFLogxK

U2 - 10.1212/WNL.0000000000201537

DO - 10.1212/WNL.0000000000201537

M3 - Article

C2 - 36351814

SN - 0028-3878

VL - 100

SP - 739

EP - 750

JO - Neurology

JF - Neurology

IS - 7

ER -

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

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