Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

Abstract

BACKGROUND:The mechanisms and outcomes in coronavirus disease (COVID-19)associated stroke are unique from those of non-COVID-19 stroke. OBJECTIVE: To describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort. METHODS: We conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020. RESULTS: The total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002). CONCLUSION: COVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/ mortality rates.

In Reply: Characteristics of a COVID-19 Cohort With Large Vessel Occlusion: A Multicenter International Study

“…We read with prodigious interest and pleasure the letter by Wang. 1 We commend the authors on their copious contribution to the field and value their time to read our work 2 and share/reflect on it through this letter.…”

“…8 However, even with shorter duration from stroke onset to hospital admission, patients with COVID-19 had higher rates of poor functional outcomes compared with non-COVID-19 patients in our study. 2 Finally, we want to thank Wang 1 for their insightful feedback and want to take this opportunity to scrutinize several points. COVID-19 is an independent predictor of poor functional outcome in patients with strokes due to large vessel occlusion.…”

Efficacy and safety of recanalization therapy for acute ischemic stroke with COVID-19: A systematic review and meta-analysis

“…After screening, 45 full articles were further assessed for eligibility. Eventually, ten studies ( 19 , 20 , 23 – 30 ) containing 7,042 patients (596 in the COVID-19 positive group and 6,446 in the COVID-19 negative group) were selected for qualitative synthesis ( Figure 1 ). Five were retrospectively designed and five were prospectively designed.…”

Evento cerebrovascular en pacientes post COVID-19

“…Encontramos un estudio que demuestra que 139 pacientes con diagnostico leve a moderado de COVID-19, desarrollaron 9 a 11 días posteriores, un evento cerebrovascular y otro estudio de casos que sugiere que los pacientes con síntomas leves de COVID-19, también pueden presentar complicaciones tromboembólicas una vez superada la fase aguda de la infección por COVID-19. (Jabbour P, et al, 2022;Ruiz-Ares G, et al, 2021) Es más frecuente encontrar pacientes con edades cada vez menores, con complicaciones posteriores a la fase aguda de COVID-19, en este estudio, encontramos que los pacientes con antecedente positivo de COVID-19 y con presencia de evento cerebrovascular, son de edad aproximada de 60 años. A diferencia de los pacientes que no tuvieron el antecedente de infección, pero si presentaron el evento cerebrovascular, que son de edad promedio a los 75 años.…”