European Multicenter Study of ET-COVID-19

Federico Cagnazzo; Michel Piotin; Simon Escalard; Benjamin Maier; Marc Ribo; Manuel Requena; Raoul Pop; Anca Hasiu; Roberto Gasparotti; Dikran Mardighian; Mariangela Piano; Amedeo Cervo; Omer Faruk Eker; Vincent Durous; Nader-Antoine Sourour; Mahmoud Elhorany; Andrea Zini; Luigi Simonetti; Simona Marcheselli; Nuzzi Nunzio Paolo; Emmanuel Houdart; Alexis Guédon; Noémie Ligot; Benjamin Mine; Arturo Consoli; Bertrand Lapergue; Pere Cordona Portela; Xabier Urra; Alejandro Rodriguez; Federico Bolognini; Pablo Ariel Lebedinsky; Anne Pasco-Papon; Sophie Godard; Gaultier Marnat; Igor Sibon; Nicola Limbucci; Patrizia Nencini; Sergio Nappini; Valentina Saia; Valentina Caldiera; Daniele Romano; Giulia Frauenfelder; Ivan Gallesio; Giuliano Gola; Roberto Menozzi; Antonio Genovese; Alberto Terrana; Elvis Lafe; Anna Cavallini; Lucio Castellan

doi:10.1161/STROKEAHA.120.031514

European Multicenter Study of ET-COVID-19

Federico Cagnazzo, Michel Piotin, Simon Escalard, Benjamin Maier, Marc Ribo, Manuel Requena, Raoul Pop, Anca Hasiu, Roberto Gasparotti, Dikran Mardighian, Mariangela Piano, Amedeo Cervo, Omer Faruk Eker, Vincent Durous, Nader-Antoine Sourour, Mahmoud Elhorany, Andrea Zini, Luigi Simonetti, Simona Marcheselli, Nuzzi Nunzio PaoloEmmanuel Houdart, Alexis Guédon, Noémie Ligot, Benjamin Mine, Arturo Consoli, Bertrand Lapergue, Pere Cordona Portela, Xabier Urra, Alejandro Rodriguez, Federico Bolognini, Pablo Ariel Lebedinsky, Anne Pasco-Papon, Sophie Godard, Gaultier Marnat, Igor Sibon, Nicola Limbucci, Patrizia Nencini, Sergio Nappini, Valentina Saia, Valentina Caldiera, Daniele Romano, Giulia Frauenfelder, Ivan Gallesio, Giuliano Gola, Roberto Menozzi, Antonio Genovese, Alberto Terrana, Elvis Lafe, Anna Cavallini, Lucio Castellan

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	31-9
Number of pages	10
Journal	Stroke
Volume	52
Issue number	1
Early online date	Nov 23 2020
DOIs	https://doi.org/10.1161/STROKEAHA.120.031514
Publication status	Published - Jan 2021

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Cagnazzo, F., Piotin, M., Escalard, S., Maier, B., Ribo, M., Requena, M., Pop, R., Hasiu, A., Gasparotti, R., Mardighian, D., Piano, M., Cervo, A., Eker, O. F., Durous, V., Sourour, N-A., Elhorany, M., Zini, A., Simonetti, L., Marcheselli, S., ... Castellan, L. (2021). European Multicenter Study of ET-COVID-19. Stroke, 52(1), 31-9. https://doi.org/10.1161/STROKEAHA.120.031514

European Multicenter Study of ET-COVID-19. / Cagnazzo, Federico; Piotin, Michel; Escalard, Simon; Maier, Benjamin; Ribo, Marc; Requena, Manuel; Pop, Raoul; Hasiu, Anca; Gasparotti, Roberto; Mardighian, Dikran; Piano, Mariangela; Cervo, Amedeo; Eker, Omer Faruk; Durous, Vincent; Sourour, Nader-Antoine; Elhorany, Mahmoud; Zini, Andrea; Simonetti, Luigi; Marcheselli, Simona; Paolo, Nuzzi Nunzio; Houdart, Emmanuel; Guédon, Alexis; Ligot, Noémie; Mine, Benjamin; Consoli, Arturo; Lapergue, Bertrand; Cordona Portela, Pere; Urra, Xabier; Rodriguez, Alejandro; Bolognini, Federico; Lebedinsky, Pablo Ariel; Pasco-Papon, Anne; Godard, Sophie; Marnat, Gaultier; Sibon, Igor; Limbucci, Nicola; Nencini, Patrizia; Nappini, Sergio; Saia, Valentina; Caldiera, Valentina; Romano, Daniele; Frauenfelder, Giulia; Gallesio, Ivan; Gola, Giuliano; Menozzi, Roberto; Genovese, Antonio; Terrana, Alberto; Lafe, Elvis ; Cavallini, Anna ; Castellan, Lucio.

In: Stroke, Vol. 52, No. 1, 01.2021, p. 31-9.

Research output: Contribution to journal › Article › peer-review

Cagnazzo, F, Piotin, M, Escalard, S, Maier, B, Ribo, M, Requena, M, Pop, R, Hasiu, A, Gasparotti, R, Mardighian, D, Piano, M, Cervo, A, Eker, OF, Durous, V, Sourour, N-A, Elhorany, M, Zini, A, Simonetti, L, Marcheselli, S, Paolo, NN, Houdart, E, Guédon, A, Ligot, N, Mine, B, Consoli, A, Lapergue, B, Cordona Portela, P, Urra, X, Rodriguez, A, Bolognini, F, Lebedinsky, PA, Pasco-Papon, A, Godard, S, Marnat, G, Sibon, I, Limbucci, N, Nencini, P, Nappini, S, Saia, V, Caldiera, V, Romano, D, Frauenfelder, G, Gallesio, I, Gola, G, Menozzi, R, Genovese, A, Terrana, A, Lafe, E , Cavallini, A & Castellan, L 2021, 'European Multicenter Study of ET-COVID-19', Stroke, vol. 52, no. 1, pp. 31-9. https://doi.org/10.1161/STROKEAHA.120.031514

Cagnazzo, Federico ; Piotin, Michel ; Escalard, Simon ; Maier, Benjamin ; Ribo, Marc ; Requena, Manuel ; Pop, Raoul ; Hasiu, Anca ; Gasparotti, Roberto ; Mardighian, Dikran ; Piano, Mariangela ; Cervo, Amedeo ; Eker, Omer Faruk ; Durous, Vincent ; Sourour, Nader-Antoine ; Elhorany, Mahmoud ; Zini, Andrea ; Simonetti, Luigi ; Marcheselli, Simona ; Paolo, Nuzzi Nunzio ; Houdart, Emmanuel ; Guédon, Alexis ; Ligot, Noémie ; Mine, Benjamin ; Consoli, Arturo ; Lapergue, Bertrand ; Cordona Portela, Pere ; Urra, Xabier ; Rodriguez, Alejandro ; Bolognini, Federico ; Lebedinsky, Pablo Ariel ; Pasco-Papon, Anne ; Godard, Sophie ; Marnat, Gaultier ; Sibon, Igor ; Limbucci, Nicola ; Nencini, Patrizia ; Nappini, Sergio ; Saia, Valentina ; Caldiera, Valentina ; Romano, Daniele ; Frauenfelder, Giulia ; Gallesio, Ivan ; Gola, Giuliano ; Menozzi, Roberto ; Genovese, Antonio ; Terrana, Alberto ; Lafe, Elvis ; Cavallini, Anna ; Castellan, Lucio. / European Multicenter Study of ET-COVID-19. In: Stroke. 2021 ; Vol. 52, No. 1. pp. 31-9.

@article{97997cae77ab4e54bb018c9e169e70c4,

title = "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.",

author = "Federico Cagnazzo and Michel Piotin and Simon Escalard and Benjamin Maier and Marc Ribo and Manuel Requena and Raoul Pop and Anca Hasiu and Roberto Gasparotti and Dikran Mardighian and Mariangela Piano and Amedeo Cervo and Eker, {Omer Faruk} and Vincent Durous and Nader-Antoine Sourour and Mahmoud Elhorany and Andrea Zini and Luigi Simonetti and Simona Marcheselli and Paolo, {Nuzzi Nunzio} and Emmanuel Houdart and Alexis Gu{\'e}don and No{\'e}mie Ligot and Benjamin Mine and Arturo Consoli and Bertrand Lapergue and {Cordona Portela}, Pere and Xabier Urra and Alejandro Rodriguez and Federico Bolognini and Lebedinsky, {Pablo Ariel} and Anne Pasco-Papon and Sophie Godard and Gaultier Marnat and Igor Sibon and Nicola Limbucci and Patrizia Nencini and Sergio Nappini and Valentina Saia and Valentina Caldiera and Daniele Romano and Giulia Frauenfelder and Ivan Gallesio and Giuliano Gola and Roberto Menozzi and Antonio Genovese and Alberto Terrana and Elvis Lafe and Anna Cavallini and Lucio Castellan",

year = "2021",

month = jan,

doi = "10.1161/STROKEAHA.120.031514",

language = "English",

volume = "52",

pages = "31--9",

journal = "Stroke",

issn = "0039-2499",

publisher = "Lippincott Williams and Wilkins",

number = "1",

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TY - JOUR

T1 - European Multicenter Study of ET-COVID-19

AU - Cagnazzo, Federico

AU - Piotin, Michel

AU - Escalard, Simon

AU - Maier, Benjamin

AU - Ribo, Marc

AU - Requena, Manuel

AU - Pop, Raoul

AU - Hasiu, Anca

AU - Gasparotti, Roberto

AU - Mardighian, Dikran

AU - Piano, Mariangela

AU - Cervo, Amedeo

AU - Eker, Omer Faruk

AU - Durous, Vincent

AU - Sourour, Nader-Antoine

AU - Elhorany, Mahmoud

AU - Zini, Andrea

AU - Simonetti, Luigi

AU - Marcheselli, Simona

AU - Paolo, Nuzzi Nunzio

AU - Houdart, Emmanuel

AU - Guédon, Alexis

AU - Ligot, Noémie

AU - Mine, Benjamin

AU - Consoli, Arturo

AU - Lapergue, Bertrand

AU - Cordona Portela, Pere

AU - Urra, Xabier

AU - Rodriguez, Alejandro

AU - Bolognini, Federico

AU - Lebedinsky, Pablo Ariel

AU - Pasco-Papon, Anne

AU - Godard, Sophie

AU - Marnat, Gaultier

AU - Sibon, Igor

AU - Limbucci, Nicola

AU - Nencini, Patrizia

AU - Nappini, Sergio

AU - Saia, Valentina

AU - Caldiera, Valentina

AU - Romano, Daniele

AU - Frauenfelder, Giulia

AU - Gallesio, Ivan

AU - Gola, Giuliano

AU - Menozzi, Roberto

AU - Genovese, Antonio

AU - Terrana, Alberto

AU - Lafe, Elvis

AU - Cavallini, Anna

AU - Castellan, Lucio

PY - 2021/1

Y1 - 2021/1

N2 - 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.

AB - 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.

U2 - 10.1161/STROKEAHA.120.031514

DO - 10.1161/STROKEAHA.120.031514

M3 - Article

C2 - 33222617

VL - 52

SP - 31

EP - 39

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 1

ER -