Effect of Asymptomatic and Symptomatic COVID-19 on Acute Ischemic Stroke Revascularization Outcomes.
Details
Serval ID
serval:BIB_D1527493BEEE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effect of Asymptomatic and Symptomatic COVID-19 on Acute Ischemic Stroke Revascularization Outcomes.
Journal
Stroke
Working group(s)
Global COVID-19 Stroke Registry
Contributor(s)
Herzig R., Członkowksa A., Demeestere J., Yassin Mansour O., Georgiopoulos G., Nogueira R.G., Salerno A., Wegener S., Baumgartner P., Cereda C.W., Bianco G., Beyeler M., Arnold M., Carrera E., Machi P., Altersberger V., Bonati L., Gensicke H., Bolognese M., Peters N., Wetzel S., Magriço M., Nuno Ramos J., Sargento-Freitas J., Machado R., Maia C., Machado E., Paiva-Nunes A., Ferreira P., Pinho-E-Melo T., Carvalho-Dias M., Paula A., Alberto Correia M., Castro P., Azevedo E., Albuquerque L., Nuno-Alves J., Ferreira-Pinto J., Meira T., Pereira L., Rodrigues M., Araújo A., Rodrigues M., Rocha M., Pereira-Fonseca Â., Ribeiro L., Varela R., Cappellari M., Zivelonghi C., Sajeva G., Zini A., Gentile M., Forlivesi S., Migliaccio L., Sessa M., Pezzini A., Sangalli D., Zedde M., Pascarella R., Diamanti S., Beretta S., Schwarz G., Frisullo G., Marcheselli S., Seners P., Sabben C., Escalard S., Piotin M., Maier B., Charbonnier G., Vuillier F., Legris L., Cuisenier P., Vodret F.R., Marnat G., Liegey J.S., Sibon I., Flottmann F., Broocks G., Gloyer N.O., Bohmann F.O., Hendrik Schaefer J., Nolte C.H., Audebert H., Siebert E., Sykora M., Lang W., Ferrari J., Mayer-Suess L., Knoflach M., Gizewski E.R., Stolp J., Stolze L.J., Coutinho J.M., Nederkoorn P.J., van-den-Wijngaard I., de Meris J., Lemmens R., De Raedt S., Vandervorst F., Pierre Rutgers M., Guilmot A., Dusart A., Bellante F., Calleja-Castaño P., Ostos F., Gonzalez-Ortega G., Martín-Jiménez P., García-Madrona S., Cruz-Culebras A., Vera R., Matute M.C., Fuentes B., Alonso-de-Leciñana M., Rigual R., Díez-Tejedor E., Pérez-Sánchez S., Montaner J., Díaz-Otero F., Perez de la Ossa N., Flores-Pina B., Muñoz-Narbona L., Chamorro A., Rodríguez-Vázquez A., Renú A., Ayo-Martin O., Hernandez-Fernandez F., Segura T., Tejada-Meza H., Hlaing T., See I., Simister R., Werring D.J., Saxhaug Kristoffersen E., Nordanstig A., Jood K., Rentzos A., Šimůnek L., Krajíčková D., Krajina A., Mikulík R., Cviková M., Vinklárek J., Školoudík D., Roubec M., Hurtikova E., Hrubý R., Ostry S., Skoda O., Pernicka M., Kočí L., Eichlová Z., Jíra M., Kovář M., Panský M., Mencl P., Paloušková H., Tomek A., Janský P., Olšerová A., Šrámek M., Havlíček R., Malý P., Trakal L., Fiksa J., Slovák M., Karliński M., Nowak M., Sienkiewicz-Jarosz H., Bochynska A., Wrona P., Homa T., Sawczynska K., Slowik A., Wlodarczyk E., Wiącek M., Tomaszewska-Lampart I., Sieczkowski B., Bartosik-Psujek H., Bilik M., Bandzarewicz A., Dorobek M., Zielińska-Turek J., Nowakowska-Kotas M., Obara K., Urbanowski P., Budrewicz S., Guziński M., Świtońska M., Rutkowska I., Sobieszak-Skura P., Łabuz-Roszak B., Dębiec A., Staszewski J., Stępień A., Zwiernik J., Wasilewski G., Tiu C., Terecoasă E.O., Radu R.A., Negrila A., Dorobat B., Panea C., Tiu V., Petrescu S., Özcan-Özdemir A., Mahmoud M., El-Samahy H., Abdelkhalek H., Al-Hashel J., Ibrahim Ismail I., Salmeen A., Ghoreishi A., Sabetay S., Gross H., Klein P., Abdalkader M., Jabbour P., El Naamani K., Tjoumakaris S., Abbas R., Mohamed G.A., Chebl A., Min J., Hovingh M., Tsai J., Khan M.A., Nalleballe K., Onteddu S., Masoud H.E., Michael M., Kaur N., Maali L., Abraham M., Khandelwal P., Bach I., Ong M., Babici D., Khawaja A.M., Hakemi M., Rajamani K., Cano-Nigenda V., Arauz A., Amaya P., Llanos N., Arango A., Vences M.A., Barrientos J.D., Caetano R., Targa R., Scollo S., Yalung P., Nagendra S., Gaikwad A., Seo K.D.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
01/2024
Peer-reviewed
Oui
Volume
55
Number
1
Pages
78-88
Language
english
Notes
Publication types: Multicenter Study ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
The association of COVID-19 with higher bleeding risk and worse outcomes in acute ischemic stroke (AIS) undergoing revascularization may be related to the presence of infection symptoms. We aimed to assess the safety and outcomes of revascularization treatments in patients with AIS with asymptomatic COVID-19 (AS-COVID) or symptomatic COVID-19 (S-COVID).
We conducted an international multicenter retrospective cohort study of consecutive AIS tested for SARS-CoV-2, receiving intravenous thrombolysis and endovascular treatment between 2020 and 2021. We compared COVID-negative controls, AS-COVID, and S-COVID using multivariable regression. We assessed symptomatic intracranial hemorrhage (symptomatic intracerebral hemorrhage), mortality, and 3-month disability (modified Rankin Scale score).
Among 15 124 patients from 105 centers (median age, 71 years; 49% men; 39% treated with intravenous thrombolysis only; and 61% with endovascular treatment±intravenous thrombolysis), 849 (5.6%) had COVID-19, of whom 395 (46%) were asymptomatic and 454 (54%) symptomatic. Compared with controls, both patients with AS-COVID and S-COVID had higher symptomatic intracerebral hemorrhage rates (COVID-controls, 5%; AS-COVID, 7.6%; S-COVID, 9.4%; adjusted odds ratio [aOR], 1.43 [95% CI, 1.03-1.99]; aOR, 1.63 [95% CI, 1.14-2.32], respectively). Only in patients with symptomatic infections, we observed a significant increase in mortality at 24 hours (COVID-controls, 1.3%; S-COVID, 4.8%; aOR, 2.97 [95% CI, 1.76-5.03]) and 3 months (COVID-controls, 19.5%; S-COVID, 40%; aOR, 2.64 [95% CI, 2.06-3.37]). Patients with COVID-19 had worse 3-month disability regardless of disease symptoms although disability was affected to a greater extent in symptomatic patients (aOR for worse modified Rankin Scale score shift: AS-COVID, 1.25 [95% CI, 1.03-1.51]; S-COVID, 2.10 [95% CI, 1.75-2.53]). S-COVID had lower successful recanalization (74.9% versus 85.6%; P<0.001), first pass recanalization (20.3% versus 28.3%; P=0.005), and a higher number of passes.
In AIS undergoing revascularization treatments, both AS-COVID and S-COVID influence the risk of intracranial bleeding and worse clinical outcomes. The magnitude of this effect is more pronounced in symptomatic infections, which also present less favorable recanalization outcomes. These findings emphasize the impact of SARS-CoV-2 infection on the prognosis of revascularized AIS independent of symptom status.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04895462.
We conducted an international multicenter retrospective cohort study of consecutive AIS tested for SARS-CoV-2, receiving intravenous thrombolysis and endovascular treatment between 2020 and 2021. We compared COVID-negative controls, AS-COVID, and S-COVID using multivariable regression. We assessed symptomatic intracranial hemorrhage (symptomatic intracerebral hemorrhage), mortality, and 3-month disability (modified Rankin Scale score).
Among 15 124 patients from 105 centers (median age, 71 years; 49% men; 39% treated with intravenous thrombolysis only; and 61% with endovascular treatment±intravenous thrombolysis), 849 (5.6%) had COVID-19, of whom 395 (46%) were asymptomatic and 454 (54%) symptomatic. Compared with controls, both patients with AS-COVID and S-COVID had higher symptomatic intracerebral hemorrhage rates (COVID-controls, 5%; AS-COVID, 7.6%; S-COVID, 9.4%; adjusted odds ratio [aOR], 1.43 [95% CI, 1.03-1.99]; aOR, 1.63 [95% CI, 1.14-2.32], respectively). Only in patients with symptomatic infections, we observed a significant increase in mortality at 24 hours (COVID-controls, 1.3%; S-COVID, 4.8%; aOR, 2.97 [95% CI, 1.76-5.03]) and 3 months (COVID-controls, 19.5%; S-COVID, 40%; aOR, 2.64 [95% CI, 2.06-3.37]). Patients with COVID-19 had worse 3-month disability regardless of disease symptoms although disability was affected to a greater extent in symptomatic patients (aOR for worse modified Rankin Scale score shift: AS-COVID, 1.25 [95% CI, 1.03-1.51]; S-COVID, 2.10 [95% CI, 1.75-2.53]). S-COVID had lower successful recanalization (74.9% versus 85.6%; P<0.001), first pass recanalization (20.3% versus 28.3%; P=0.005), and a higher number of passes.
In AIS undergoing revascularization treatments, both AS-COVID and S-COVID influence the risk of intracranial bleeding and worse clinical outcomes. The magnitude of this effect is more pronounced in symptomatic infections, which also present less favorable recanalization outcomes. These findings emphasize the impact of SARS-CoV-2 infection on the prognosis of revascularized AIS independent of symptom status.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04895462.
Keywords
Male, Humans, Aged, Female, Stroke/therapy, Stroke/drug therapy, Ischemic Stroke/epidemiology, Ischemic Stroke/surgery, Brain Ischemia/epidemiology, Brain Ischemia/surgery, Thrombolytic Therapy, Retrospective Studies, Treatment Outcome, COVID-19/complications, COVID-19/therapy, SARS-CoV-2, Cerebral Hemorrhage/complications, Intracranial Hemorrhages/complications, Thrombectomy, Endovascular Procedures, endothelial cells, ischemic stroke, renin-angiotensin system, thrombosis
Pubmed
Web of science
Open Access
Yes
Create date
09/01/2024 0:05
Last modification date
27/01/2024 8:36
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