European Multicenter Study of ET-COVID-19
Authors: 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 , Giorgianni Andrea , Cappellari Manuel , Augelli Raffaele , Invernizzi Paolo , Pavia Marco , Lafe Elvis , Cavallini Anna , Giossi Alessia , Besana Michele , Valvassori Luca , Macera Antonio , Castellan Lucio , Salsano Giancarlo , Di Caterino Fortunato , Biondi Alessandra , Arquizan Caroline , Lebreuche Julien , Galvano Gianluca , Cannella Alfio , Cosottini Mirco , Lazzarotti Guido , Guizzardi Giuseppe , Stecco Alessandro , Tassi Rossana , Bracco Sandra , Bianchini Elena , Micieli Camilla , Pascarella Rosario , Napoli Manuela , Causin Francesco , Desal Hubert , Cotton François , Costalat Vincent , Delvoye François , Ciccio Gabriele , Smajda Stanislas , Redjem Hocine , Hébert Solène , Blanc Raphaël , Mazighi Mikael , Desilles Jean-Philippes , Mihoc Dan , Manisor Monica , Beaujeux Rémy , Quenardelle Véronique , Gheoca Roxana , Wolff Valérie , Pero Guiglielmo , Giuditta Giussani , Chiara Ceresa , Riva Roberto , Cappucci Matteo , Laubacher Morgane , Tuttle Celia , Piergallini Lorenzo , Turjman Francis , Clarençon Frédéric , Shotar Eimad , Lenck Stéphanie , Premat Kevin , Degos Vincent , Samson Yves , Rosso Charlotte , Alamowitch Sonia , Cirillo Luigi , Gentile Mauro , Migliaccio Ludovica , Isceri Salvatore , Rossi Simone , Baldini Tommaso , Dall’Olio Massimo , Cellerini Martino , Saint-Maurice Jean-Pierre , Civelli Vittorio , Fantoni Matteo , Gilles Naeije , Lise Jodaïtis , Boris Lubicz , Elens Stephanie , Thomas Bonnet , Adrien Guenego , Niloufar Sadeghi , Marc Van Nuffelen , Maria Federico Di , Coskun Oguzhan , Rodesch Georges , Zimatore Sergio , Florent Gariel , Berge Jérôme , Menegon Patrice , Barreau Xavier , Tourdias Thomas , Olindo Stéphane , Lucas Ludovic , Liegey Jean-Sebastien , Sagnier Sharmila , Renou Pauline , Couture Marie , Debruxelles Sabrina , Poli Mathilde , Musacchio Mariano , Delaitre Mariette , Padolecchia Riccardo , Ganci Giuseppe , Sugo Annalisa , Stefano Barbero , Giovanni Taverna Giacomo , Scoditti Umberto , Castellini Paola , Latte Lilia , Grisendi Ilaria , Epifani Enrico , Vizzari Francesco , Molinaro Stefano , Nativo Luca , Vinacci Gabriele , Bonetti Bruno , Micheletti Nicola , Tomelleri Giampaolo , Zampieri Piergiuseppe , Plebani Mauro , Grazioli Andrea , Ricciardi Giuseppe Kenneth , Polistena Alessandra , Alessando Sgreccia , Sanfilippo Giuseppina , Persico Alessandra , Boadu William , Cuzzoni Maria Giovanna , Magno Serena , Toscano Gianpaolo , Denaro Maria Federica , Tosi Piera , Censori Bruno , Puglisi Valentina , Vinciguerra Luisa , De Giuli Valeria , Mavillo Nicola , Renieri Leonardo , Fainardi Enrico , Vitale Giovanni , Panagiotis Primikiris , Charbonnier Guillaume , Claudio Moratti , Sallustio Fabrizio , Wlderk Andrea , Russo Riccardo , Bergui Mauro , Comelli Chiara , Boghi Andrea , Moynier Marinette , Maria Ciceri Elisa Francesca , Toni Danilo , Frandon Julien , Mourand Isabelle , Gaillard Nicolas , Mangiafico Salvatore , Derraz Imad , Dargazanli Cyril , Lefevre Pierre-Henri , Riquelme Carlos , Gascou Gregory , Bonafe Alain 
Published: November 2020

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 CT 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 CT 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.