Sawczyńska Katarzyna, Wrona Paweł, Kęsek Tomasz, Wnuk Marcin, Chrzan Robert, Homa Tomasz, Pułyk Roman, Jagiełła Jeremiasz, Popiela Tadeusz, Słowik Agnieszka
Department of Neurology, Jagiellonian University Medical College, Krakow, Poland.
Department of Neurology, University Hospital in Krakow, Poland.
Neurol Neurochir Pol. 2022;56(2):163-170. doi: 10.5603/PJNNS.a2022.0026. Epub 2022 Mar 22.
The aim of this study was to assess the clinical profiles and outcomes of patients with confirmed COVID-19 infection and acute ischaemic stroke (AIS) treated with mechanical thrombectomy (MT) at the Comprehensive Stroke Centre (CSC) of the University Hospital in Krakow.
COVID-19 is a risk factor for AIS and worsens prognosis in patients with large artery occlusions. During the pandemic, the global number of MT has dropped. At the same time, studies assessing outcomes of this treatment in COVID-19-associated AIS have produced divergent results.
In this single-centre study, we retrospectively analysed and compared the clinical profiles (age, sex, presence of cardiovascular risk factors, neurological deficit at admission), stroke size (measured using postprocessing analysis of perfusion CT with RAPID software), time from stroke onset to arrival at the CSC, time from arrival at the CSC to groin puncture, treatment with intravenous thrombolysis, length of hospitalisation, laboratory test results, and short-term outcomes (measured with Thrombolysis in Cerebral Infarction scale, modified Rankin Scale and National Health Institute Stroke Scale) in patients with AIS treated with MT during the pandemic. A comparison between patients with and without concomitant SARS-CoV2 infection was then performed.
There were no statistically significant differences between 15 COVID (+) and 167 COVID (-) AIS patients treated with AIS with respect to clinical profiles (p > 0.05), stroke size (p > 0.05) or outcomes (NIHSS at discharge, 8.1 (SD = 7.1) vs. 8.8 (SD = 9.6), p = 0.778, mRS at discharge 2.9 (SD = 2) vs. 3.1 (SD = 2.1), p = 0.817, death rate 6.7% vs. 12.6%, p = 0.699). There was a significant difference between patients with and without COVID-19 concerning time from arrival at the CSC to groin puncture [104.27 (SD = 51.47) vs. 97.63 (SD = 156.94) min., p = 0.044] and the length of hospitalisation [23.7 (SD = 11.9) vs. 10.5 (SD = 6.9) days, p < 0.001].
In AIS patients treated with MT, concomitant SARS-CoV2 infection did not affect the outcome. Our observations need to be confirmed in larger, and preferably multicentre, studies.
本研究旨在评估在克拉科夫大学医院综合卒中中心接受机械取栓术（MT）治疗的确诊新型冠状病毒肺炎（COVID-19）感染且合并急性缺血性卒中（AIS）患者的临床特征及预后。
COVID-19是AIS的一个危险因素，会使大动脉闭塞患者的预后恶化。在疫情期间，全球MT的数量有所下降。与此同时，评估该治疗方法在COVID-19相关AIS患者中的预后研究结果不一。
在这项单中心研究中，我们回顾性分析并比较了疫情期间接受MT治疗的AIS患者的临床特征（年龄、性别、心血管危险因素的存在情况、入院时的神经功能缺损）、卒中大小（使用RAPID软件对灌注CT进行后处理分析测量）、从卒中发作到抵达综合卒中中心的时间、从抵达综合卒中中心到腹股沟穿刺的时间、静脉溶栓治疗、住院时间、实验室检查结果以及短期预后（使用脑梗死溶栓量表、改良Rankin量表和美国国立卫生研究院卒中量表测量）。然后对合并和未合并严重急性呼吸综合征冠状病毒2（SARS-CoV2）感染的患者进行了比较。
15例COVID（+）和167例COVID（-）的AIS患者在临床特征（p>0.05）、卒中大小（p>0.05）或预后（出院时美国国立卫生研究院卒中量表评分，8.1（标准差=7.1）对8.8（标准差=9.6），p=0.778；出院时改良Rankin量表评分2.9（标准差=2）对3.1（标准差=2.1），p=0.817；死亡率6.7%对12.6%，p=0.699）方面无统计学显著差异。合并和未合并COVID-19的患者在从抵达综合卒中中心到腹股沟穿刺的时间[104.27（标准差=51.47）对97.63（标准差=156.94）分钟，p=0.044]和住院时间[23.7（标准差=11.9）对10.5（标准差=6.9）天，p<0.001]上存在显著差异。
在接受MT治疗的AIS患者中，合并SARS-CoV2感染并未影响预后。我们的观察结果需要在更大规模、最好是多中心的研究中得到证实。
