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Updated: Aug 12, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Recombinant tissue plasminogen activator (rTPA) management for first onset acute ischemic stroke with covid -19 and
Eman M Khedr1, Ahmed Abdelwarith2, Gehad Moussa2
1Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University, Assiut, Egypt.
Insights
Thrombolytic therapy with recombinant tissue plasminogen activator (rTPA) is safe and effective for acute ischemic stroke (AIS) patients with or without COVID-19. Despite higher risks of bleeding and death in COVID-19 patients, outcomes were comparable.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiovascular Research
Background:
- Cerebrovascular stroke (CVS) is a known complication of COVID-19.
- Limited data exists on the safety and efficacy of thrombolytic therapy in COVID-19 stroke patients.
Purpose of the Study:
- To compare the efficacy and safety of recombinant tissue plasminogen activator (rTPA) in acute ischemic stroke (AIS) patients with and without COVID-19 infection.
Main Methods:
- A prospective comparative study of AIS patients eligible for rTPA.
- Patients were divided into two groups: AIS with COVID-19 and AIS without COVID-19 (controls).
- NIHSS and mRS scores were assessed pre-treatment, post-treatment, and at 3-month follow-up.
Main Results:
- COVID-19 patients had higher rates of smoking, diabetes, and more severe motor symptoms on admission.
- Higher incidence of symptomatic intracranial hemorrhage and hemorrhagic transformation was observed in the COVID-19 group.
- While reperfusion times were longer in COVID-19 patients, clinical improvement, re-occlusion rates, and recurrent strokes at 3 months did not differ. However, mortality was higher in the COVID-19 group (27.3% vs. 16%).
Conclusions:
- rTPA is a safe and effective treatment for AIS in patients with or without COVID-19.
- Increased risk of hemorrhagic transformation and mortality in COVID-19 patients should be considered.
- Further research is warranted to optimize treatment strategies for this patient population.
Objectives:
Cerebrovascular stroke (CVS) is one of the well-known complications of coronavirus-2019 (Covid-19), but less is known about the outcome and safety of thrombolytic therapy in these patients. In this study we compare the efficacy and safety of Tissue plasminogen activator (rTPA) in acute ischemic stroke (AIS) patients with or without Covid-19 infection.
Materials And Methods:
A comparative prospective study in which all patients who presented with AIS and eligible for rTPA were recruited from the emergency department and classified into 2 groups (AIS with Covid-19 infection and AIS without Covid-19 as controls). Demographic data, symptoms of Covid-19, clinical examination, neuroimaging, and laboratory investigations were obtained in each patient. National Institute of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS) were assessed before, immediately after rTPA, and 3 months later.
Results:
There were 22 patients in the COVID-19 group and 25 control patients. Those with COVID-19 were more likely to have a history of smoking and Diabetes Mellitus than controls. On admission, motor symptoms were more severe in patients with COVID-19. COVID-19 patients were more likely to have symptomatic intra-cerebral hemorrhage and radiological hemorrhagic transformation than controls. Onset to door time (ODT) and onset to successful reperfusion time were significantly longer in Covid-19 patients than controls. Clinical improvement and frequency of re-occlusion and recurrent ischemic stroke at 3 months follow-up did not differ between groups, although there was higher number of deaths (27.3%) in the Covid-19 group than controls (16%).
Conclusions:
Using rTPA is safe and effective in patients with AIS with or without COVID-19 infection despite the high frequency of hemorrhagic transformation and high number of deaths.
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