A single-centre experience of intravenous thrombolysis for stroke in COVID-19 patients

Sangalli, Davide; Polonia, Valeria; Colombo, Daniele; Mantero, Vittorio; Filizzolo, Marco; Scaccabarozzi, Chiara; Salmaggi, Andrea

doi:10.1007/s10072-020-04591-3

Cited by 19 publications

(18 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For the small number of cases of COVID-19 patients who have also suffered AIS and received reperfusion therapy, consisting of intravenous thrombolysis or endovascular thrombectomy or a combination of both, the outcomes have not been particularly positive. In a case series regarding four patients with COVID-19-related AIS who also received systemic thrombolysis, all died ( 126 ). Similarly, in COVID-19-infected stroke patients reported in a healthcare system in New York who received alteplase and mechanical thrombectomy, the neurological outcomes were also poor ( 94 ).…”

Section: Results and Analysismentioning

confidence: 99%

COVID-19 Pathophysiology Predicts That Ischemic Stroke Occurrence Is an Expectation, Not an Exception—A Systematic Review

2021

View full text Add to dashboard Cite

Clinical reports of neurological manifestations associated with severe coronavirus disease 2019 (COVID-19), such as acute ischemic stroke (AIS), encephalopathy, seizures, headaches, acute necrotizing encephalitis, cerebral microbleeds, posterior reversible leukoencephalopathy syndrome, hemophagocytic lymphohistiocytosis, peripheral neuropathy, cranial nerve palsies, transverse myelitis, and demyelinating disorders, are increasing rapidly. However, there are comparatively few studies investigating the potential impact of immunological responses secondary to hypoxia, oxidative stress, and excessive platelet-induced aggregation on the brain. This scoping review has focused on the pathophysiological mechanisms associated with peripheral and consequential neural (central) inflammation leading to COVID-19-related ischemic strokes. It also highlights the common biological processes shared between AIS and COVID-19 infection and the importance of the recognition that severe respiratory dysfunction and neurological impairments associated with COVID and chronic inflammation [post-COVID-19 neurological syndrome (PCNS)] may significantly impact recovery and ability to benefit from neurorehabilitation. This study provides a comprehensive review of the pathobiology of COVID-19 and ischemic stroke. It also affirms that the immunological contribution to the pathophysiology of COVID-19 is predictive of the neurological sequelae particularly ischemic stroke, which makes it the expectation rather than the exception. This work is of fundamental significance to the neurorehabilitation community given the increasing number of COVID-related ischemic strokes, the current limited knowledge regarding the risk of reinfection, and recent reports of a PCNS. It further highlights the need for global collaboration and research into new pathobiology-based neurorehabilitation treatment strategies and more integrated evidence-based care.

show abstract

Section: Results and Analysismentioning

confidence: 99%

COVID-19 Pathophysiology Predicts That Ischemic Stroke Occurrence Is an Expectation, Not an Exception—A Systematic Review

2021

View full text Add to dashboard Cite

show abstract

“…Under these circumstances, it therefore becomes essential that recommendations and guidelines on stroke care be modified as per emergency medical situations, and neurologists follow what may be aptly termed as a "protected stroke code" instead of the regularly practised stroke codes. [131][132][133][134][135] RECOMMENDATIONS FOR MANAGING STROKE DURING COVID-19 [131][132][133][134][135][136][137][138][139][140] First, apart from the regular screening methods used by paramedics before transferring the patient to appropriate centres, COVID-19 pandemic mandates the use of additional screening protocol, including that of an infection control screen and a travel history screen for all patients, based on the recommendations of WHO or CDC. 1,141,142 They must complete screening the patient for infection, assessing for features such as fever, cough, chest pain, headache, myalgia, shortness of breath and gastrointestinal symptoms like vomiting or diarrhea.…”

Section: Role Of Neurologistsmentioning

confidence: 99%

“…Previous studies have shown that the use of rt-PA in patients with ischemic stroke and higher levels of inflammatory markers has foreseen a greater risk of ICH and poorer prognosis. [138][139][140] The presence of hepatic dysfunction may further add to the potential threat of ICH, as rt-PA is metabolised in the liver, 144 and any dysfunction will lead to decreased clearance of the drug. Apart from a detailed coagulation profile, other tools like thromboelastography go a long way in helping neurologists weigh the risks against the benefits of rt-PA administration.…”

Section: Role Of Neurologistsmentioning

confidence: 99%

Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic

Roy

Ghosh

Dubey

et al. 2020

Can. J. Neurol. Sci.

167

186

View full text Add to dashboard Cite

Background: Albeit primarily a disease of respiratory tract, the 2019 coronavirus infectious disease (COVID-19) has been found to have causal association with a plethora of neurological, neuropsychiatric and psychological effects. This review aims to analyze them with a discussion of evolving therapeutic recommendations. Methods: PubMed and Google Scholar were searched from 1 January 2020 to 30 May 2020 with the following key terms: “COVID-19”, “SARS-CoV-2”, “pandemic”, “neuro-COVID”, “stroke-COVID”, “epilepsy-COVID”, “COVID-encephalopathy”, “SARS-CoV-2-encephalitis”, “SARS-CoV-2-rhabdomyolysis”, “COVID-demyelinating disease”, “neurological manifestations”, “psychosocial manifestations”, “treatment recommendations”, “COVID-19 and therapeutic changes”, “psychiatry”, “marginalised”, “telemedicine”, “mental health”, “quarantine”, “infodemic” and “social media”. A few newspaper reports related to COVID-19 and psychosocial impacts have also been added as per context. Results: Neurological and neuropsychiatric manifestations of COVID-19 are abundant. Clinical features of both central and peripheral nervous system involvement are evident. These have been categorically analyzed briefly with literature support. Most of the psychological effects are secondary to pandemic-associated regulatory, socioeconomic and psychosocial changes. Conclusion: Neurological and neuropsychiatric manifestations of this disease are only beginning to unravel. This demands a wide index of suspicion for prompt diagnosis of SARS-CoV-2 to prevent further complications and mortality.

show abstract

“…The sample sizes are limited in both studies; thus, further investigation on larger cohort is required to confirm the existing findings. At the moment, it is not a rare event to treat AIS with rt-PA in COVID-19 patients (Cappellari et al 2020 ; Carneiro et al 2020 ; Co et al 2020 ; Escalard et al 2020 ; Sangalli et al 2020 ), but no sufficient evidence could confirm the efficacy of this treatment, and no clear regulation is available to prohibit the use of rt-PA just due to the abnormal laboratory indicators. Therefore, clinicians should be aware of the inherent risk of rt-PA treatment for patients with COVID-19 and stroke.…”

Section: Rapid Vascular Recanalization For Covid-19 Patients With Sudmentioning

confidence: 99%

Potential mechanisms of cerebrovascular diseases in COVID-19 patients

et al. 2021

View full text Add to dashboard Cite

Since the outbreak of coronavirus disease 2019 (COVID-19) in 2019, it is gaining worldwide attention at the moment. Apart from respiratory manifestations, neurological dysfunction in COVID-19 patients, especially the occurrence of cerebrovascular diseases (CVD), has been intensively investigated. In this review, the effects of COVID-19 infection on CVD were summarized as follows: (I) angiotensin-converting enzyme 2 (ACE2) may be involved in the attack on vascular endothelial cells by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), leading to endothelial damage and increased subintimal inflammation, which are followed by hemorrhage or thrombosis; (II) SARS-CoV-2 could alter the expression/activity of ACE2, consequently resulting in the disruption of renin-angiotensin system which is associated with the occurrence and progression of atherosclerosis; (III) upregulation of neutrophil extracellular traps has been detected in COVID-19 patients, which is closely associated with immunothrombosis; (IV) the inflammatory cascade induced by SARS-CoV-2 often leads to hypercoagulability and promotes the formation and progress of atherosclerosis; (V) antiphospholipid antibodies are also detected in plasma of some severe cases, which aggravate the thrombosis through the formation of immune complexes; (VI) hyperglycemia in COVID-19 patients may trigger CVD by increasing oxidative stress and blood viscosity; (VII) the COVID-19 outbreak is a global emergency and causes psychological stress, which could be a potential risk factor of CVD as coagulation, and fibrinolysis may be affected. In this review, we aimed to further our understanding of CVD-associated COVID-19 infection, which could improve the therapeutic outcomes of patients. Personalized treatments should be offered to COVID-19 patients at greater risk for stroke in future clinical practice.

show abstract

A single-centre experience of intravenous thrombolysis for stroke in COVID-19 patients

Cited by 19 publications

References 10 publications

COVID-19 Pathophysiology Predicts That Ischemic Stroke Occurrence Is an Expectation, Not an Exception—A Systematic Review

COVID-19 Pathophysiology Predicts That Ischemic Stroke Occurrence Is an Expectation, Not an Exception—A Systematic Review

Neurological and Neuropsychiatric Impacts of COVID-19 Pandemic

Potential mechanisms of cerebrovascular diseases in COVID-19 patients

Contact Info

Product

Resources

About