open access
Mechanical thrombectomy in COVID-19-associated ischaemic stroke: patient characteristics and outcomes in a single-centre study
Affiliations- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital in Krakow, Poland
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
- Department of Radiology, University Hospital in Krakow, Poland
- University Hospital in Krakow, Poland
open access
Abstract
Introduction. The aim of this study was to assess the clinical profiles and outcomes of patients with confirmed COVID-19 infection and acute ischaemic stroke (AIS) treated with mechanical thrombectomy (MT) at the Comprehensive Stroke Centre (CSC) of the University Hospital in Krakow.
Clinical rationale for the study. COVID-19 is a risk factor for AIS and worsens prognosis in patients with large artery occlusions. During the pandemic, the global number of MT has dropped. At the same time, studies assessing outcomes of this treatment in COVID-19-associated AIS have produced divergent results.
Material and methods. In this single-centre study, we retrospectively analysed and compared the clinical profiles (age, sex, presence of cardiovascular risk factors, neurological deficit at admission), stroke size (measured using postprocessing analysis of perfusion CT with RAPID software), time from stroke onset to arrival at the CSC, time from arrival at the CSC to groin puncture, treatment with intravenous thrombolysis, length of hospitalisation, laboratory test results, and short-term outcomes (measured with Thrombolysis in Cerebral Infarction scale, modified Rankin Scale and National Health Institute Stroke Scale) in patients with AIS treated with MT during the pandemic. A comparison between patients with and without concomitant SARS-CoV2 infection was then performed.
Results. There were no statistically significant differences between 15 COVID (+) and 167 COVID (–) AIS patients treated with AIS with respect to clinical profiles (p > 0.05), stroke size (p > 0.05) or outcomes (NIHSS at discharge, 8.1 (SD = 7.1) vs. 8.8 (SD = 9.6), p = 0.778, mRS at discharge 2.9 (SD = 2) vs. 3.1 (SD = 2.1), p = 0.817, death rate 6.7% vs. 12.6%, p = 0.699). There was a significant difference between patients with and without COVID-19 concerning time from arrival at the CSC to groin puncture [104.27 (SD = 51.47) vs. 97.63 (SD = 156.94) min., p = 0.044] and the length of hospitalisation [23.7 (SD = 11.9) vs. 10.5 (SD = 6.9) days, p < 0.001].
Conclusion. In AIS patients treated with MT, concomitant SARS-CoV2 infection did not affect the outcome. Our observations need to be confirmed in larger, and preferably multicentre, studies.
Abstract
Introduction. The aim of this study was to assess the clinical profiles and outcomes of patients with confirmed COVID-19 infection and acute ischaemic stroke (AIS) treated with mechanical thrombectomy (MT) at the Comprehensive Stroke Centre (CSC) of the University Hospital in Krakow.
Clinical rationale for the study. COVID-19 is a risk factor for AIS and worsens prognosis in patients with large artery occlusions. During the pandemic, the global number of MT has dropped. At the same time, studies assessing outcomes of this treatment in COVID-19-associated AIS have produced divergent results.
Material and methods. In this single-centre study, we retrospectively analysed and compared the clinical profiles (age, sex, presence of cardiovascular risk factors, neurological deficit at admission), stroke size (measured using postprocessing analysis of perfusion CT with RAPID software), time from stroke onset to arrival at the CSC, time from arrival at the CSC to groin puncture, treatment with intravenous thrombolysis, length of hospitalisation, laboratory test results, and short-term outcomes (measured with Thrombolysis in Cerebral Infarction scale, modified Rankin Scale and National Health Institute Stroke Scale) in patients with AIS treated with MT during the pandemic. A comparison between patients with and without concomitant SARS-CoV2 infection was then performed.
Results. There were no statistically significant differences between 15 COVID (+) and 167 COVID (–) AIS patients treated with AIS with respect to clinical profiles (p > 0.05), stroke size (p > 0.05) or outcomes (NIHSS at discharge, 8.1 (SD = 7.1) vs. 8.8 (SD = 9.6), p = 0.778, mRS at discharge 2.9 (SD = 2) vs. 3.1 (SD = 2.1), p = 0.817, death rate 6.7% vs. 12.6%, p = 0.699). There was a significant difference between patients with and without COVID-19 concerning time from arrival at the CSC to groin puncture [104.27 (SD = 51.47) vs. 97.63 (SD = 156.94) min., p = 0.044] and the length of hospitalisation [23.7 (SD = 11.9) vs. 10.5 (SD = 6.9) days, p < 0.001].
Conclusion. In AIS patients treated with MT, concomitant SARS-CoV2 infection did not affect the outcome. Our observations need to be confirmed in larger, and preferably multicentre, studies.
Keywords
acute ischaemic stroke, COVID-19, mechanical thrombectomy, large artery occlusion
About this articleTitle
Mechanical thrombectomy in COVID-19-associated ischaemic stroke: patient characteristics and outcomes in a single-centre study
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Research Paper
Pages
163-170
Published online
2022-03-22
Page views
5177
Article views/downloads
717
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2022;56(2):163-170.
Keywords
acute ischaemic stroke
COVID-19
mechanical thrombectomy
large artery occlusion
Authors
Katarzyna Sawczyńska
Paweł Wrona
Tomasz Kęsek
Marcin Wnuk
Robert Chrzan
Tomasz Homa
Roman Pułyk
Jeremiasz Jagiełła
Tadeusz Popiela
Agnieszka Słowik
References (18)- Wnuk M, Sawczyńska K, Kęsek T, et al. Neurological symptoms in hospitalised patients with COVID-19 and their association with in-hospital mortality. Neurol Neurochir Pol. 2021; 55(3): 314–321.
- Belani P, Schefflein J, Kihira S, et al. COVID-19 is an independent risk factor for acute ischemic stroke. AJNR Am J Neuroradiol. 2020; 41(8): 1361–1364.
- Nannoni S, de Groot R, Bell S, et al. Stroke in COVID-19: A systematic review and meta-analysis. Int J Stroke. 2021; 16(2): 137–149.
- Siow I, Lee K, Zhang J, et al. Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors. Journal of Stroke and Cerebrovascular Diseases. 2021; 30(3): 105549.
- Khandelwal P, Al-Mufti F, Tiwari A, et al. Incidence, characteristics and outcomes of large vessel stroke in COVID-19 cohort: an international multicenter study. Neurosurgery. 2021; 89(1): E35–E41.
- Altschul DJ, Esenwa C, Haranhalli N, et al. Predictors of mortality for patients with COVID-19 and large vessel occlusion. Interv Neuroradiol. 2020; 26(5): 623–628.
- Nogueira RG, Abdalkader M, Qureshi MM, et al. Global impact of COVID-19 on stroke care. Int J Stroke. 2021; 16(5): 573–584.
- Kurnianto A, Tugasworo D, Andhitara Y, et al. Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) in COVID-19 pandemic: a systematic review. Egypt J Neurol Psychiatr Neurosurg. 2021; 57(1): 67.
- Słowik A, Nowak R, Popiela T. Significant fall in stroke admissions in the Malopolska Voivodeship of Poland during the COVID-19 pandemic. Neurol Neurochir Pol. 2020; 54(5): 471–472.
- Derbisz J, Nowak K, Wnuk M, et al. Prognostic significance of stroke-associated infection and other readily available parameters in acute ischemic stroke treated by intravenous thrombolysis. J Stroke Cerebrovasc Dis. 2021; 30(2): 105525.
- Nogueira RG, Jadhav AP, Haussen DC, et al. DAWN Trial Investigators. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018; 378(1): 11–21.
- Albers GW, Marks MP, Kemp S, et al. DEFUSE 3 Investigators. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. N Engl J Med. 2018; 378(8): 708–718.
- Chrzan R, Bociąga-Jasik M, Bryll A, et al. Differences among COVID-19, Bronchopneumonia and Atypical Pneumonia in Chest High Resolution Computed Tomography Assessed by Artificial Intelligence Technology. J Pers Med. 2021; 11(5).
- Monaco CG, Zaottini F, Schiaffino S, et al. Chest x-ray severity score in COVID-19 patients on emergency department admission: a two-centre study. Eur Radiol Exp. 2020; 4(1): 68.
- Escalard S, Maïer B, Redjem H, et al. Treatment of acute ischemic stroke due to large vessel occlusion with COVID-19: experience from paris. Stroke. 2020; 51(8): 2540–2543.
- Cagnazzo F, Piotin M, Escalard S, et al. European Multicenter Study of ET-COVID-19. Stroke. 2021; 52(1): 31–39.
- Pop R, Hasiu A, Bolognini F, et al. Stroke thrombectomy in patients with COVID-19: initial experience in 13 cases. AJNR Am J Neuroradiol. 2020; 41(11): 2012–2016.
- Al Kasab S, Almallouhi E, Alawieh A, et al. STAR collaborators. International experience of mechanical thrombectomy during the COVID-19 pandemic: insights from STAR and ENRG. J Neurointerv Surg. 2020; 12(11): 1039–1044.
