Case-series and cohort studies have shown the feasibility of reperfusion therapies in patients with ischemic stroke and COVID-19, but due to the absence of a contemporary control group of non-COVID-19 patients, small sample size or lack of long-term outcome assessment, concerns regarding safety and efficacy of these treatments remain to be clarified. Taking into account its limitations, some studies documented higher rates of endovascular treatment complications such as clot fragmentation with distal embolization and vessel re-oclusion, to be more difficult to achieve recanalization after endovascular treatment, and higher rates of any intracerebral hemmorhage. The investigators aim is to assess in a large, multicenter and international cohort, the safety and outcomes of acute reperfusion therapies in patients with ischemic stroke and COVID-19, by comparison with a contemporary control group of patients with ischemic stroke and without COVID-19 from the same centers.
Study Type
OBSERVATIONAL
Enrollment
15,128
Lausanne University Hospital
Lausanne, Switzerland
Rate of symptomatic intracranial hemorrhage
Symptomatic parenchymal hemorrhagic transformation according to the ECASS-2 (European-Australasian Acute Stroke Study - II) definition, and/or subarachnoid hemorrhage with ≥4-point worsening in NIHSS (National Institute of Health Stroke Scale)
Time frame: 36 hours
Rate of any hemorrhagic transformation
According to the ECASS-2 (European-Australasian Acute Stroke Study - II) definition
Time frame: 36 hours
Rate of recanalization after endovascular treatment measured by mTICI (modified treatment in cerebral infarction)
Only in EVT patients
Time frame: End of procedure
Rate of successful recanalization after endovascular treatment (defined as final mTICI [modified treatment in cerebral infarction] ≥2b)
Only in EVT patients
Time frame: End of procedure
Number of passes during endovascular treatment
Only in EVT patients
Time frame: End of procedure
Rate of first pass effect during endovascular treatment
Only in EVT patients
Time frame: End of procedure
Rate of procedural complication (Arterial perforation, embolization into a previously non-ischemic territory, and re-occlusion)
Only in EVT patients
Time frame: End of procedure
Delta NIHSS (National Institute of Health Stroke Scale) at 24 hours
Difference between admission NIHSS and NIHSS at 24 hours. NIHSS is a scale used to quantify the severity of neurological deficits after stroke: 0 (no signs) to 42 (very severe stroke)
Time frame: 24 hours
3-month modified Rankin Scale (mRS)
Functional outcome assessed with mRS at 3-month follow-up. The mRS is an ordinal scale that assigns patients among 7 levels of disability: 0 (no symptom) to 5 (severe disability) and 6 (death)
Time frame: 3 months
3-month favorable outcome
Favorable outcome defined as modified Rankin Scale (mRS) ≤2 or equal to pre-stroke mRS
Time frame: 3 months
3-month mortality
Mortality assessed at 3-month follow-up
Time frame: 3 months
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