European Multicenter Study of ET-COVID-19

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.

Advances in mechanical thrombectomy for acute ischaemic stroke from large vessel occlusions

“…53 European Multicenter Study of ET-COVID-19 also pointed out a higher rate of 30-day mortality (29%) after MT among patients with AIS with COVID-19. 54 We need immediate consideration of a new streamline of MT for AIS-LVO with COVID-19 in the contexts of the pandemic evolution. 52 56 SKIP used lower dose of tPA (0.6 mg/kg).…”

Glial Cells as Therapeutic Approaches in Brain Ischemia-Reperfusion Injury

“…During 2020, a new risk factor for stroke occurrence has emerged related to COVID-19. Some reports indicated that COVID-19-related strokes are more severe and occur in younger patients than usual strokes, probably owing to coagulation abnormalities induced by SARS-CoV-2 infection [ 5 , 6 ]. The incidence of stroke in COVID-19 patients ranges from 1% to 6% [ 7 ].…”

Mechanical Thrombectomy Outcomes in COVID-19 Patients With Acute Ischemic Stroke

“…While some studies reported on young patients in their thirties with an obvious male predominance, 5 , 10 other studies reported a high frequency of MT in older male COVID-19 patients with a median age of more than 70 years. 13 – 15 Overall, according to a meta-analysis of 50 studies, COVID-19 patients with acute cerebrovascular disease were found to be younger than stroke patients with no SARS-CoV-2 infection (pooled median difference=6.0 y). 16 In a parallel manner, COVID-19 patients who underwent mechanical thrombectomy were younger than uninfected patients who underwent MT during both the pandemic 6 and before the pandemic (Table 1 ).…”

“… 17 Interestingly, in addition to being younger, some studies on MT reported many COVID-19 patients with AIS lacking traditional vascular risk factors, 5 , 10 although many other studies described the presence of these risk factors (eg, hypertension, diabetes and cardiovascular disease) in COVID-19 patients treated with MT. 6 , 13 – 15 …”

“… 3 , 27 , 28 This was consistent with studies on COVID-19 patients who underwent MT (Table 1 ). 10 , 13 , 17 , 18 Importantly, specific laboratory findings in COVID-19 patients may have diagnostic, prognostic, and possible therapeutic implications. 13 , 29 – 32 An example of the prognostic value of such data is from studies on COVID-19 pneumonia patients which suggest that high levels of D-dimer, interleukin-6, LDH, and ferritin on admission, along with abnormal coagulation values—all of which were frequently found in COVID-19 patients who underwent MT 10 , 13 , 17 , 18 —are associated with a higher mortality risk.…”