Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19 Experience From Paris
Treatment of Acute Ischemic Stroke due to Large Vessel Occlusion With COVID-19 Experience From Paris
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DOI：
10.1161/strokeaha.120.030574
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发表时间：
2020-08-01
期刊：
影响因子：
8.3
通讯作者：
Piotin, Michel
中科院分区：
文献类型：
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作者：
Escalard, Simon;Maier, Benjamin;Piotin, Michel
背景和目的：在2019冠状病毒病（COVID-19）患者中观察到更高的中风率，但缺乏关于COVID-19患者因大血管闭塞（LVO）而患急性缺血性中风的结局数据。我们报告了使用LVO治疗COVID-19患者急性缺血性卒中的初步经验。研究方法：纳入了在COVID-19爆发的前6周内在我们机构治疗的所有因LVO导致急性缺血性卒中的COVID-19连续患者。报告了基线临床和放射学结果、治疗和短期结局。结果：我们确定了10名确诊为COVID-19的患者，他们因LVO而接受急性缺血性卒中治疗。其中8人为男性，中位年龄为59.5岁。7人在中风发作时没有或有轻微的COVID-19症状。从COVID-19症状到中风发作的中位时间为6天。所有患者在症状发作后3小时内进行了脑成像。5例患者有多区域LVO。5例接受静脉注射阿替普酶。所有患者均接受了机械血栓切除术。9例患者成功再通（mTICI 2B-3），无早期神经功能改善，4例早期脑再闭塞，共有6例患者（60%）在医院死亡。结论：最好的医疗护理，包括早期静脉溶栓，以及通过机械血栓切除术实现的成功和迅速再通，导致COVID-19患者的结局较差。虽然我们的结果需要进一步确认，但应研究不同的药理学方法（抗血小板或其他），以考虑与COVID-19相关的炎症和凝血障碍。
Background and Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.