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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Reperfusion Therapies for Acute Ischemic Stroke in COVID-19 Patients: A Nationwide Multi-Center Study
Justina Jurkevičienė1, Mantas Vaišvilas1, Rytis Masiliūnas2
1Stroke Centre, Republican Vilnius University Hospital, 04130 Vilnius, Lithuania.
Insights
Reperfusion therapies for acute ischemic stroke in COVID-19 patients are safe but lead to worse functional outcomes and higher mortality. Further research is needed for these stroke patients.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiovascular Research
Background:
- Acute ischemic stroke (AIS) is a recognized complication of COVID-19.
- Limited data exists on the safety and efficacy of reperfusion therapies (RT) in COVID-19 stroke patients.
- Reperfusion therapies include intravenous thrombolysis and endovascular treatment (EVT).
Purpose of the Study:
- To evaluate the safety and efficacy of reperfusion therapies in COVID-19 patients with AIS.
- To compare functional outcomes and mortality between COVID-19 patients and matched controls undergoing RT.
- To assess neurological status and complication rates after RT in AIS patients with and without COVID-19.
Main Methods:
- Retrospective, nationwide, multi-center, pair-matched analysis.
- Included adult COVID-19 patients with AIS treated with RT (March 2020 - June 2021).
- Matched COVID-19 patients with non-infected controls based on age, sex, vascular territory, and RT modality.
Main Results:
- Thirty-one COVID-19 patients were matched with 31 controls.
- Higher baseline NIHSS scores in COVID-19 patients (16 vs. 12).
- Similar rates of ischemic changes and symptomatic intracerebral hemorrhage.
- Worse 24-hour NIHSS scores (16 vs. 5) and lower favorable functional outcomes (mRS 0-2: 22.6% vs. 51.8%) in COVID-19 patients.
- Significantly higher 3-month mortality in COVID-19 patients (54.8% vs. 12.9%).
Conclusions:
- Reperfusion therapies for AIS in COVID-19 patients appear safe in terms of immediate complications.
- COVID-19 is associated with significantly poorer functional outcomes post-RT.
- Higher 3-month mortality rates underscore the severity of stroke in COVID-19 patients undergoing RT.
Abstract:
(1) Background: Acute ischemic stroke (AIS) is a possible complication of the coronavirus disease 2019 (COVID-19). Safety and efficacy data on reperfusion therapies (RT)-intravenous thrombolysis and endovascular treatment (EVT)-in stroke patients with COVID-19 is lacking. (2) Methods: We performed a retrospective nationwide multi-center pair-matched analysis of COVID-19 patients with AIS who underwent RT. We included adult COVID-19 patients with AIS who were treated with RT between 16 March 2020 and 30 June 2021. All subjects were paired with non-infected controls, matched for age, sex, stroke arterial vascular territory, and RT modality. The primary outcome measure was a favorable functional outcome defined by the modified Rankin scale (mRS 0-2). (3) Results: Thirty-one subjects and thirty-one matched controls were included. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was higher in the COVID-19 group (16 vs. 12, p = 0.028). Rates of ischemic changes and symptomatic intracerebral hemorrhages did not differ significantly between the two groups at 24 h after RT. The median NIHSS 24 h after reperfusion remained significantly higher in the COVID-19 group (16 vs. 5, p = 0.003). MRS 0-2 at discharge was significantly less common in COVID-19 patients (22.6% vs. 51.8%, p = 0.018). Three-month mortality was 54.8% in the COVID-19 group versus 12.9% in controls (p = 0.001). (4) Conclusion: Reperfusion therapies on AIS in COVID-19 patients appear to be safe; however, functional outcomes are significantly worse, and 3-month mortality is higher.
