About 5% of COVID-19 patients may present symptoms related to acute ischemic stroke (AIS). Treatment-management and outcomes related to mechanical thrombectomy (MT) for COVID-19 infected patients harboring large vessel occlusion is largely unknown. This multicentric study aims to investigate morbidity, mortality and neurological outcomes after MT performed in patients with COVID-19 infection.
Since the identification of the first case of Severe Acute Respiratory Syndrome (SARS) CoV-2
infection in December 2019 in Wuhan, China, the global number of confirmed COVID-19 cases is
roughly 5 000 000, with 216 involved countries. Increasing evidence shows that SARS-CoV-2 may
be associated with neurological manifestations, with up to 36% of patients showing
neurological symptoms related to the neurovirulence of the SARS-CoV-2.
It has been reported that roughly 5% of COVID-19 infected patients may present acute ischemic
stroke (AIS), and these patients may have an unfavorable clinical evolution due to the
systemic involvement of the infective disease. In addition, these patients are quite young:
the mean age of COVID-19 patients having AIS is lower (56 years), compared to general
population of AIS patients (mean age=73 years). Moreover, most of these patients require an
intensive care units (ICU) management. Stroke mechanisms may be multiple and can include
hypercoagulability from critical illness, cardioembolism from virus-related cardiac injury,
and severe inflammation. Indeed, the dysfunction of endothelial cells induced by infection
may promote an increased thrombin generation and fibrinolysis; moreover, the hypoxia found in
severe COVID-19 patients can be a trigger for thrombosis, increasing blood viscosity, and
inducing hypoxia-inducible transcription factors.
Outcomes related to the treatment of COVID-19 patients harboring large vessel occlusion and
requiring MT is substantially unknown, but it is likely that the combined morbidity and
mortality rate of the two pathologies is high. Accordingly, patient's selection,
treatment-management, and results should be urgently elucidated.
Involving 4 different countries (France, Italy, Spain, and US), this multicentric cohort
study aims to analyze the largest possible number of COVID-19 infected patients treated with
MT for AIS, with the intention to provide treatment-results and neurological outcomes,
elucidating the best patient-selection and treatment-management.
Other: Mechanical Trombectomy
Stent retriever for treatment of cerebral arterial occlusions
Inclusion criteria:
- Patients >18 years infected with the SARR-CoV-2 with acute ischemic stroke, and eligible
for mechanical thrombectomy (based on the current guide-lines)
Exclusion criteria:
- Patients <18 years ; no eligibility to mechanical thrombectomy ; absence of diagnosis of
COVID-19
Uhmontpellier
Montpellier, France
Federico Cagnazzo, MD PhD, Principal Investigator
UH Montpellier