Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19: Experience From Paris

Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ische...

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Published in:	Stroke (1970) Vol. 51; no. 8; p. 2540
Main Authors:	Escalard, Simon, Maïer, Benjamin, Redjem, Hocine, Delvoye, François, Hébert, Solène, Smajda, Stanislas, Ciccio, Gabriele, Desilles, Jean-Philippe, Mazighi, Mikael, Blanc, Raphael, Piotin, Michel
Format:	Journal Article
Language:	English
Published:	United States 01.08.2020
Subjects:	Aged Arterial Occlusive Diseases - complications Arterial Occlusive Diseases - diagnostic imaging Blood Coagulation Disorders - etiology Brain - diagnostic imaging Brain Ischemia - diagnostic imaging Brain Ischemia - etiology Brain Ischemia - therapy Cerebral Arteries Cerebral Veins Coronavirus Infections - complications COVID-19 Female Hospital Mortality Humans Male Middle Aged Pandemics Plasminogen Activators - therapeutic use Pneumonia, Viral - complications Stroke - diagnostic imaging Stroke - etiology Stroke - therapy Thrombectomy Thrombolytic Therapy Time-to-Treatment Tissue Plasminogen Activator - therapeutic use Treatment Outcome COVID-19 outbreak coagulation disorder stroke thrombectomy
ISSN:	1524-4628, 1524-4628
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Abstract	Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19. All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported. We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital. Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.
AbstractList	Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19.BACKGROUND AND PURPOSEHigher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19.All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported.METHODSAll consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported.We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital.RESULTSWe identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital.Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.CONCLUSIONSBest medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19. Higher rates of strokes have been observed in patients with coronavirus disease 2019 (COVID-19), but data regarding the outcomes of COVID-19 patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) are lacking. We report our initial experience in the treatment of acute ischemic stroke with LVO in patients with COVID-19. All consecutive patients with COVID-19 with acute ischemic stroke due to LVO treated in our institution during the 6 first weeks of the COVID-19 outbreak were included. Baseline clinical and radiological findings, treatment, and short-term outcomes are reported. We identified 10 patients with confirmed COVID-19 treated for an acute ischemic stroke due to LVO. Eight were men, with a median age of 59.5 years. Seven had none or mild symptoms of COVID-19 at stroke onset. Median time from COVID-19 symptoms to stroke onset was 6 days. All patients had brain imaging within 3 hours from symptoms onset. Five patients had multi-territory LVO. Five received intravenous alteplase. All patients had mechanical thrombectomy. Nine patients achieved successful recanalization (mTICI2B-3), none experienced early neurological improvement, 4 had early cerebral reocclusion, and a total of 6 patients (60%) died in the hospital. Best medical care including early intravenous thrombolysis, and successful and prompt recanalization achieved with mechanical thrombectomy, resulted in poor outcomes in patients with COVID-19. Although our results require further confirmation, a different pharmacological approach (antiplatelet or other) should be investigated to take in account inflammatory and coagulation disorders associated with COVID-19.
Author	Escalard, Simon Delvoye, François Mazighi, Mikael Blanc, Raphael Redjem, Hocine Hébert, Solène Smajda, Stanislas Desilles, Jean-Philippe Ciccio, Gabriele Maïer, Benjamin Piotin, Michel
Author_xml	– sequence: 1 givenname: Simon surname: Escalard fullname: Escalard, Simon organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 2 givenname: Benjamin surname: Maïer fullname: Maïer, Benjamin organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 3 givenname: Hocine surname: Redjem fullname: Redjem, Hocine organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 4 givenname: François surname: Delvoye fullname: Delvoye, François organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 5 givenname: Solène surname: Hébert fullname: Hébert, Solène organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 6 givenname: Stanislas surname: Smajda fullname: Smajda, Stanislas organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 7 givenname: Gabriele surname: Ciccio fullname: Ciccio, Gabriele organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 8 givenname: Jean-Philippe surname: Desilles fullname: Desilles, Jean-Philippe organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 9 givenname: Mikael surname: Mazighi fullname: Mazighi, Mikael organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 10 givenname: Raphael surname: Blanc fullname: Blanc, Raphael organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France – sequence: 11 givenname: Michel surname: Piotin fullname: Piotin, Michel organization: From the Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France
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SubjectTerms	Aged Arterial Occlusive Diseases - complications Arterial Occlusive Diseases - diagnostic imaging Blood Coagulation Disorders - etiology Brain - diagnostic imaging Brain Ischemia - diagnostic imaging Brain Ischemia - etiology Brain Ischemia - therapy Cerebral Arteries Cerebral Veins Coronavirus Infections - complications COVID-19 Female Hospital Mortality Humans Male Middle Aged Pandemics Plasminogen Activators - therapeutic use Pneumonia, Viral - complications Stroke - diagnostic imaging Stroke - etiology Stroke - therapy Thrombectomy Thrombolytic Therapy Time-to-Treatment Tissue Plasminogen Activator - therapeutic use Treatment Outcome
Title	Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19: Experience From Paris
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