M Cappellari1, A Zini2, D Sangalli3, A Cavallini4, M Reggiani5, F N Sepe6, N Rifino7, G Giussani8, D Guidetti9, M Zedde10, S Marcheselli11, M Longoni12, S Beretta13, V Sidoti14, D M Papurello15, A Giossi16, P Nencini17, M Plocco18, M Balestrino19, E Rota20, D Toni21. 1. Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona. 2. IRCCS Istituto di Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna. 3. UO di Neurologia-Stroke Unit, Ospedale Alessandro Manzoni-ASST, Lecco. 4. UC Malattie Cerebrovascolari-Stroke Unit, IRCCS Fondazione Mondino, Pavia. 5. Neurologia, ASLTO3, Rivoli. 6. Stroke Unit-Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria. 7. Stroke Unit, Ospedale Papa Giovanni XXIII, Bergamo. 8. Neurologia-Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan. 9. U.O.C. Neurologia, Ospedale Guglielmo da Saliceto, Piacenza. 10. Patologia Cerebrovascolare-Stroke Unit, Arcispedale Santa Maria Nuova, Reggio Emilia. 11. Sezione Autonoma di Neurologia d'Urgenza e Stroke Unit Humanitas Research Hospital, Rozzano. 12. Neurologia-Stroke Unit, Ospedale M. Bufalini-AUSL Romagna, Cesana. 13. Department of Neurology and Stroke Unit, San Gerardo Hospital, ASST Monza, Monza. 14. UOS Stroke Unit, ASST Franciacorta, Chiari. 15. Neurologia, ASLTO4, Ciriè. 16. UO Neurologia-ASST Cremona. 17. SOD Stroke Unit, Dipartimento DEA, AOU Careggi, Florence. 18. Stroke Unit, F. Spaziani, Frosinone. 19. Centro Ictus, Ospedale Policlinico San Martino, Genoa. 20. Neurologia, Ospedale S. Giacomo, Novi Ligure. 21. Department of Human Neurosciences, Sapienza University, Rome, Italy.
Abstract
BACKGROUND AND PURPOSE: Comorbidity of acute ischaemic stroke with Covid-19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1-month outcome in ischaemic stroke patients with Covid-19 infection who received IVT alone or before thrombectomy (bridging therapy). METHODS: As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on stroke patients with Covid-19 who received IVT. RESULTS: Seventy-five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patients died and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1-month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died. CONCLUSIONS: Intravenous thrombolysis for patients with stroke and Covid-19 was not a rare event in the most affected areas by pandemic, and rates of 1-month unfavorable outcomes were high compared to previous data from the pre-Covid-19 literature. However, risk of sICH was not increased.
BACKGROUND AND PURPOSE: Comorbidity of acute ischaemic stroke with Covid-19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1-month outcome in ischaemic strokepatients with Covid-19infection who received IVT alone or before thrombectomy (bridging therapy). METHODS: As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on strokepatients with Covid-19 who received IVT. RESULTS: Seventy-five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patientsdied and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1-month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died. CONCLUSIONS: Intravenous thrombolysis for patients with stroke and Covid-19 was not a rare event in the most affected areas by pandemic, and rates of 1-month unfavorable outcomes were high compared to previous data from the pre-Covid-19 literature. However, risk of sICH was not increased.
Authors: Ali Alhashim; Mustafa Alqarni; Majed Alabdali; Mohammed Alshurem; Aishah Albakr; Kawther Hadhiah; Danah Aljaafari; Rawan Alyami Journal: Int Med Case Rep J Date: 2021-08-29