Stroke . European Multicenter Study of ET-COVID-19

[tetano]

Stroke


. 2020 Nov 23;STROKEAHA120031514.
doi: 10.1161/STROKEAHA.120.031514. Online ahead of print.
European Multicenter Study of ET-COVID-19


Federico Cagnazzo ¹ , Michel Piotin ² , Simon Escalard ² , Benjamin Maier ² , Marc Ribo ³ , Manuel Requena ³ , Raoul Pop ⁴ , Anca Hasiu ⁴ , Roberto Gasparotti ⁵ , Dikran Mardighian ⁵ , Mariangela Piano ⁶ , Amedeo Cervo ⁶ , Omer Faruk Eker ⁷ , Vincent Durous ⁷ , Nader-Antoine Sourour ⁸ , Mahmoud Elhorany ⁸ , Andrea Zini ⁹ , Luigi Simonetti ¹⁰ , Simona Marcheselli ¹¹ , Nuzzi Nunzio Paolo ¹¹ , Emmanuel Houdart ¹² , Alexis Gu?don ¹² , No?mie Ligot ¹³ , Benjamin Mine ¹³ , Arturo Consoli ¹⁴ , Bertrand Lapergue ¹⁴ , Pere Cordona Portela ¹⁵ , Xabier Urra ¹⁶ , Alejandro Rodriguez ¹⁶ , Federico Bolognini ¹⁷ , Pablo Ariel Lebedinsky ¹⁷ , Anne Pasco-Papon ¹⁸ , Sophie Godard ¹⁹ , Gaultier Marnat ²⁰ , Igor Sibon ²¹ , Nicola Limbucci ²² , Patrizia Nencini ²³ , Sergio Nappini ²² , Valentina Saia ²⁴ , Valentina Caldiera ²⁴ , Daniele Romano ²⁵ , Giulia Frauenfelder ²⁵ , Ivan Gallesio ²⁶ , Giuliano Gola ²⁶ , Roberto Menozzi ²⁷ , Antonio Genovese ²⁷ , Alberto Terrana ²⁸ , Andrea Giorgianni ²⁸ , Manuel Cappellari ²⁹ , Raffaele Augelli ²⁹ , Paolo Invernizzi ³⁰ , Marco Pavia ³⁰ , Elvis Lafe ³¹ , Anna Cavallini ³² , Alessia Giossi ³³ , Michele Besana ³³ , Luca Valvassori ³⁴ , Antonio Macera ³⁴ , Lucio Castellan ³⁵ , Giancarlo Salsano ³⁵ , Fortunato Di Caterino ³⁶ , Alessandra Biondi ³⁶ , Caroline Arquizan ³⁷ , Julien Lebreuche ³⁸ , Gianluca Galvano ³⁹ , Alfio Cannella ³⁹ , Mirco Cosottini ⁴⁰ , Guido Lazzarotti ⁴⁰ , Giuseppe Guizzardi ⁴¹ , Alessandro Stecco ⁴¹ , Rossana Tassi ⁴² , Sandra Bracco ⁴² , Elena Bianchini ⁴³ , Camilla Micieli ⁴³ , Rosario Pascarella ⁴⁴ , Manuela Napoli ⁴⁴ , Francesco Causin ⁴⁵ , Hubert Desal ⁴⁶ , Fran?ois Cotton ⁷ , Vincent Costalat ¹ , ET-COVID-19 Study Group



Collaborators, Affiliations

• PMID: 33222617
• DOI: 10.1161/STROKEAHA.120.031514

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 Computed Tomography 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 Computed Tomography 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.

Keywords: COVID-19; cerebral infarction; intracranial hemorrhage; lymphocyte count; thrombectomy.