Stroke Unit, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata, Verona.
IRCCS Istituto di Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna.
Eur J Neurol. 2020 Dec;27(12):2641-2645. doi: 10.1111/ene.14511. Epub 2020 Oct 15.
Comorbidity of acute ischaemic stroke with Covid-19 is a challenging condition, potentially influencing the decision of whether to administer intravenous thrombolysis (IVT). We aimed to assess the 1-month outcome in ischaemic stroke patients with Covid-19 infection who received IVT alone or before thrombectomy (bridging therapy).
As a collaboration initiative promoted by the Italian Stroke Organization, all Italian stroke units (n = 190) were contacted and invited to participate in data collection on stroke patients with Covid-19 who received IVT.
Seventy-five invited centers agreed to participate. Thirty patients received IVT alone and 17 received bridging therapy between 21 February 2020 and 30 April 2020 in 20 centers (n = 18, Northern Italy; n = 2, Central Italy). At 1 month, 14 (30.4%) patients died and 20 (62.5%) survivors had a modified Rankin Scale (mRS) score of 3 to 5. At 24 to 36 hours, asymptomatic intracerebral hemorrhage (ICH) was reported in eight (17.4%) patients and symptomatic ICH (sICH) in two (4.3%) patients. Causes of death were severe ischaemic stroke (n = 8), a new ischaemic stroke (n = 2), acute respiratory failure (n = 1), acute renal failure (n = 1), acute myocardial infarction (n = 1), and endocarditis (n = 1). In survivors with a 1-month mRS score of 3 to 5, baseline glucose level was higher, whereas endovascular procedure time in cases of bridging therapy was longer. Baseline National Institutes of Health Stroke Scale glucose and creatinine levels were higher in patients who died.
Intravenous thrombolysis for patients with stroke and Covid-19 was not a rare event in the most affected areas by pandemic, and rates of 1-month unfavorable outcomes were high compared to previous data from the pre-Covid-19 literature. However, risk of sICH was not increased.
急性缺血性卒中合并新冠肺炎是一种具有挑战性的情况，可能会影响是否给予静脉溶栓治疗（IVT）的决策。我们旨在评估单独接受 IVT 或在取栓术（桥接治疗）前接受 IVT 的新冠肺炎感染缺血性卒中患者的 1 个月结局。
作为意大利卒中组织推动的合作倡议，联系了所有意大利卒中单元（n=190），邀请他们参与新冠肺炎接受 IVT 的卒中患者的数据收集。
75 家受邀中心同意参与。30 名患者接受单独 IVT，20 名患者在 20 家中心（北部意大利 n=18，中部意大利 n=2）接受桥接治疗。1 个月时，14 名（30.4%）患者死亡，20 名（62.5%）幸存者的改良 Rankin 量表（mRS）评分为 3 至 5。24 至 36 小时时，8 名（17.4%）患者报告无症状性颅内出血（ICH），2 名（4.3%）患者报告症状性 ICH（sICH）。死亡原因包括严重缺血性卒中（n=8）、新发缺血性卒中（n=2）、急性呼吸衰竭（n=1）、急性肾衰竭（n=1）、急性心肌梗死（n=1）和心内膜炎（n=1）。1 个月 mRS 评分为 3 至 5 的幸存者中，基线血糖水平较高，而桥接治疗病例的血管内操作时间较长。死亡患者的基线国立卫生研究院卒中量表血糖和肌酐水平较高。
在受大流行影响最严重的地区，新冠肺炎患者接受静脉溶栓治疗并非罕见事件，与新冠肺炎前文献中的先前数据相比，1 个月不良结局的发生率较高。然而，sICH 的风险并未增加。
