Federico Cagnazzo1, Michel Piotin2, Simon Escalard2, Benjamin Maier2, Marc Ribo3, Manuel Requena3, Raoul Pop4, Anca Hasiu4, Roberto Gasparotti5, Dikran Mardighian5, Mariangela Piano6, Amedeo Cervo6, Omer Faruk Eker7, Vincent Durous7, Nader-Antoine Sourour8, Mahmoud Elhorany8, Andrea Zini9, Luigi Simonetti10, Simona Marcheselli11, Nuzzi Nunzio Paolo11, Emmanuel Houdart12, Alexis Guédon12, Noémie Ligot13, Benjamin Mine13, Arturo Consoli14, Bertrand Lapergue14, Pere Cordona Portela15, Xabier Urra16, Alejandro Rodriguez16, Federico Bolognini17, Pablo Ariel Lebedinsky17, Anne Pasco-Papon18, Sophie Godard19, Gaultier Marnat20, Igor Sibon21, Nicola Limbucci22, Patrizia Nencini23, Sergio Nappini22, Valentina Saia24, Valentina Caldiera24, Daniele Romano25, Giulia Frauenfelder25, Ivan Gallesio26, Giuliano Gola26, Roberto Menozzi27, Antonio Genovese27, Alberto Terrana28, Andrea Giorgianni28, Manuel Cappellari29, Raffaele Augelli29, Paolo Invernizzi30, Marco Pavia30, Elvis Lafe31, Anna Cavallini32, Alessia Giossi33, Michele Besana33, Luca Valvassori34, Antonio Macera34, Lucio Castellan35, Giancarlo Salsano35, Fortunato Di Caterino36, Alessandra Biondi36, Caroline Arquizan37, Julien Lebreuche38, Gianluca Galvano39, Alfio Cannella39, Mirco Cosottini40, Guido Lazzarotti40, Giuseppe Guizzardi41, Alessandro Stecco41, Rossana Tassi42, Sandra Bracco42, Elena Bianchini43, Camilla Micieli43, Rosario Pascarella44, Manuela Napoli44, Francesco Causin45, Hubert Desal46, François Cotton7, Vincent Costalat1. 1. Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France (F. Cagnazzo, V. Costalat). 2. Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France (M. Piotin, S.E., B. Maier). 3. Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Catalonia, Spain (M. Ribo, M. Requena). 4. Department of Interventional Neuroradiology, Strasbourg University Hospitals (R.P., A.H.). 5. Neuroradiology and Stroke Units, Spedali Civili, Brescia, Italy (R.G., D.M.). 6. Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy (M. Piano, A. Cervo). 7. Department of Diagnostic and Interventional Neuroradiology, Hospices Civils, Lyon, France (O.F.E., V.D., F. Cotton). 8. Department of Neuroradiology, Pitié Salpêtrière Hospital, Paris, France (N.-A.S., M.E.). 9. Department of Neurology and Stroke Center (A.Z.), IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy. 10. Neuroradiology Unit (L.S.), IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy. 11. Neurologia d'Urgenza e Stroke Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy (S.M., N.N.P.). 12. Department of Neurology, Hôpital Lariboisière, University of Paris, France (E.H., A. Guédon). 13. Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium (N. Ligot, B. Mine). 14. Department of Diagnostic and Therapeutic Neuroradiology, Hôpital Foch Suresnes FR, University of Versailles Saint Quentin-en-Yvelines, France (A. Consoli, B.L.). 15. Stroke Unit, Hospital Universitario de Bellvitge, Barcelona, Spain (P.C.P.). 16. Comprehensive Stroke Unit, Hospital Clínic de Barcelona, Catalonia, Spain (X.U., A.R.). 17. Interventional Neuroradiology Department, CHRU Colmar, France (F.B., P.A.L.). 18. Department of Radiology, University Hospital of Angers, France (A.P.-P.). 19. Department of Neurology, Angers University Hospital, France (S.G.). 20. Interventional Neuroradiology Department, CHRU Bordeaux, France (G.M.). 21. Stroke Unit, Department of Neurology, Bordeaux University, CHRU Bordeaux; France (I.S.). 22. Department of Interventional Neuroradiology, University of Florence, Italy (N. Limbucci, S.N.). 23. Stroke Unit, Ospedale Careggi-University Hospital, Firenze, Italy (P.N.). 24. Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure (V.S., V. Caldiera). 25. Department of Neuroradiology, "San Giovanni di Dio e Ruggi d'Aragona" Hospital, Salerno, Italy (D.R., G.F.). 26. Department of Radiology, Azienda ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy (I.G., G. Gola). 27. Headache Centre, Department of Medicine and Surgery, Parma, Italy (R.M., A. Genovese). 28. Department of Neuroradiology, ASST Sette Laghi, University of Insubria, Varese, Italy (A.T., A. Giorgianni). 29. Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., R.A.). 30. Neuroradiology and Neurology Units, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy (P.I., M. Pavia). 31. Radiology, Diagnostic and Interventional Neuroradiology Unit, Policlinico IRCCS San Matteo, Pavia, Italy (E.L.). 32. Cerebrovascular Department, IRCCS Mondino Foundation, Pavia, Italy (A. Cavallini). 33. SC Neurologia, Dipartimento Interaziendale Neuroscienze, Cremona, Italy (A. Giossi, M.B.). 34. Department of Neuroradiology, ASST Monza, Italy (L.V., A.M.). 35. RCCS Ospedale Policlinico San Martino, Genova, Italia (L.C., G.S.). 36. Department of Neuroradiology and Endovascular Therapy, Besancon, France (F.D.C., A.B.). 37. Department of Neurology, Hôpital Gui de Chauliac, Montpellier, France (C.A.). 38. Department of Biostatistics, University of Lille, CHU Lille, EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, France (J.L.). 39. ARNAS Garibaldi, Catania, Italy (G. Galvano, A. Cannella). 40. Neuroradiology Unit, Ospedale Cisanello, Pisa, Italy (M.C., G.L.). 41. A.O.U. Maggiore della Carita, Novara, Italy (G. Guizzardi, A.S.). 42. Interventional Neuroradiology and Stroke Units, Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy (R.T., S.B.). 43. Neuroradiology Unit, ASST West Milan, Legnano Hospital (E.B., C.M.). 44. Neuroradiology Unit, IRCCS Santa Maria Nuova, Hospital Reggio Emilia (R.P. M.N.). 45. Interventional Neuroradiology Unit and Stroke Unit, Padova, Italy (F. Causin). 46. Service de Neuroradiologie Diagnostique et Interventionnelle du CHU de Nantes, France (H.D.).
Abstract
BACKGROUND AND PURPOSE: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. METHODS: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. SECONDARY OUTCOMES: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0-1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. RESULTS: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59-79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11-21) and 8 (interquartile range, 7-9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3-87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20-39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8-29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7-12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21-5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22-5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43-12.91] per SD-log increase in LDH). CONCLUSIONS: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient's profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04406090.
BACKGROUND AND PURPOSE: Acute ischemic stroke and large vessel occlusion can be concurrent with the coronavirus disease 2019 (COVID-19) infection. Outcomes after mechanical thrombectomy (MT) for large vessel occlusion in patients with COVID-19 are substantially unknown. Our aim was to study early outcomes after MT in patients with COVID-19. METHODS: Multicenter, European, cohort study involving 34 stroke centers in France, Italy, Spain, and Belgium. Data were collected between March 1, 2020 and May 5, 2020. Consecutive laboratory-confirmed COVID-19 cases with large vessel occlusion, who were treated with MT, were included. Primary investigated outcome: 30-day mortality. SECONDARY OUTCOMES: early neurological improvement (National Institutes of Health Stroke Scale improvement ≥8 points or 24 hours National Institutes of Health Stroke Scale 0-1), successful reperfusion (modified Thrombolysis in Cerebral Infarction grade ≥2b), and symptomatic intracranial hemorrhage. RESULTS: We evaluated 93 patients with COVID-19 with large vessel occlusion who underwent MT (median age, 71 years [interquartile range, 59-79]; 63 men [67.7%]). Median pretreatment National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT Score were 17 (interquartile range, 11-21) and 8 (interquartile range, 7-9), respectively. Anterior circulation acute ischemic stroke represented 93.5% of cases. The rate modified Thrombolysis in Cerebral Infarction 2b to 3 was 79.6% (74 patients [95% CI, 71.3-87.8]). Thirty-day mortality was 29% (27 patients [95% CI, 20-39.4]). Early neurological improvement was 19.5% (17 patients [95% CI, 11.8-29.5]), and symptomatic intracranial hemorrhage was 5.4% (5 patients [95% CI, 1.7-12.1]). Patients who died at 30 days exhibited significantly lower lymphocyte count, higher levels of aspartate, and LDH (lactate dehydrogenase). After adjustment for age, initial National Institutes of Health Stroke Scale, Alberta Stroke Program Early CT Score, and successful reperfusion, these biological markers remained associated with increased odds of 30-day mortality (adjusted odds ratio of 2.70 [95% CI, 1.21-5.98] per SD-log decrease in lymphocyte count, 2.66 [95% CI, 1.22-5.77] per SD-log increase in aspartate, and 4.30 [95% CI, 1.43-12.91] per SD-log increase in LDH). CONCLUSIONS: The 29% rate of 30-day mortality after MT among patients with COVID-19 is not negligible. Abnormalities of lymphocyte count, LDH and aspartate may depict a patient's profiles with poorer outcomes after MT. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT04406090.
Authors: Pascal Jabbour; Adam A Dmytriw; Ahmad Sweid; Michel Piotin; Kimon Bekelis; Nader Sourour; Eytan Raz; Italo Linfante; Guilherme Dabus; Max Kole; Mario Martínez-Galdámez; Shahid M Nimjee; Demetrius K Lopes; Ameer E Hassan; Peter Kan; Mohammad Ghorbani; Michael R Levitt; Simon Escalard; Symeon Missios; Maksim Shapiro; Frédéric Clarençon; Mahmoud Elhorany; Daniel Vela-Duarte; Rizwan A Tahir; Patrick P Youssef; Aditya S Pandey; Robert M Starke; Kareem El Naamani; Rawad Abbas; Bassel Hammoud; Ossama Y Mansour; Jorge Galvan; Joshua T Billingsley; Abolghasem Mortazavi; Melanie Walker; Mahmoud Dibas; Fabio Settecase; Manraj K S Heran; Anna L Kuhn; Ajit S Puri; Bijoy K Menon; Sanjeev Sivakumar; Ashkan Mowla; Salvatore D'Amato; Alicia M Zha; Daniel Cooke; Mayank Goyal; Hannah Wu; Jake Cohen; David Turkel-Parrella; Andrew Xavier; Muhammad Waqas; Vincent M Tutino; Adnan Siddiqui; Gaurav Gupta; Anil Nanda; Priyank Khandelwal; Cristina Tiu; Pere C Portela; Natalia Perez de la Ossa; Xabier Urra; Mercedes de Lera; Juan F Arenillas; Marc Ribo; Manuel Requena; Mariangela Piano; Guglielmo Pero; Keith De Sousa; Fawaz Al-Mufti; Zafar Hashim; Sanjeev Nayak; Leonardo Renieri; Mohamed A Aziz-Sultan; Thanh N Nguyen; Patricia Feineigle; Aman B Patel; James E Siegler; Khodr Badih; Jonathan A Grossberg; Hassan Saad; M Reid Gooch; Nabeel A Herial; Robert H Rosenwasser; Stavropoula Tjoumakaris; Ambooj Tiwari Journal: Neurosurgery Date: 2022-03-07 Impact factor: 5.315
Authors: Amr Ehab El-Qushayri; Abdullah Reda; Abdullah Dahy; Ahmed Y Azzam; Sherief Ghozy Journal: Rev Med Virol Date: 2022-07-14 Impact factor: 11.043
Authors: Ivó H Hernández; Mario Villa-González; Gerardo Martín; Manuel Soto; María José Pérez-Álvarez Journal: Cells Date: 2021-06-30 Impact factor: 6.600