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1. Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality

Author

Nguyen, T.N. Qureshi, M.M. Klein, P. Yamagami, H. Abdalkader, M. Mikulik, R. Sathya, A. Mansour, O.Y. Czlonkowska, A. Lo, H. Field, T.S. Charidimou, A. Banerjee, S. Yaghi, S. Siegler, J.E. Sedova, P. Kwan, J. de Sousa, D.A. Demeestere, J. Inoa, V. Omran, S.S. Zhang, L. Michel, P. Strambo, D. Marto, J.P. Nogueira, R.G. Lereis, V.P. Ma, A. Enzinger, C. Gattringer, T. Rahman, A. Bonnet, T. De Raedt, S. Lemmens, R. Ligot, N. Vandervorst, F. Conforto, A.B. Hidalgo, R.C.T. Cuervo, D.L.M. Neves, L.O. da Silva, I.L. Martins, R.T. Rebello, L.C. Santiago, I.B. Alexiev, F. Sakelarova, T. Kalpachki, R. Cora, E.A. Kelly, M.E. Pikula, A. Chen, H.-S. Chen, Y. Yang, S. Bedekovic, M.R. Čabal, M. Tenora, D. Dušek, P. Fibrich, P. Hrabanovska, E. Hlaváčová, H. Jurák, L. Kadlckova, J. Karpowicz, I. Klečka, L. Kovář, M. Neumann, J. Paloušková, H. Reiser, M. Rohan, V. Skoda, O. Škorňa, M. Šimůnek, L. Šrámek, M. Drenck, N. Sobh, K. Strbian, D. Lesaine, E. Reiner, P. Rouanet, F. Sabben, C. Boskamp, S. Mbroh, J. Nagel, S. Poli, S. Rosenkranz, M. Thomalla, G. Karapanayiotides, T. Kargiotis, O. Koutroulou, I. Palaiodimou, L. Tsivgoulis, G. Guerra, J.D.B. Huded, V. Nagendra, S. Prajapati, C. Sylaja, P.N. Sani, A.F. Ghoreishi, A. Hashemilar, M. Sadeghi-Hokmabadi, E. Rahal, F. Sabetay, S.I. Acampa, M. Adami, A. Longoni, M. Ornello, R. Renieri, L. Romoli, M. Sacco, S. Salmaggi, A. Sangalli, D. Zini, A. Fujita, K. Fukuda, H. Matsumaru, Y. Miyake, K. Ohara, N. Sakaguchi, M. Sakai, K. Shindo, S. Sonoda, K. Sugiura, Y. Takenobu, Y. Toyoda, K. Uwatoko, T. Yamamoto, R. Yazawa, Y. Yoshimoto, T. Baek, J.-H. Lee, J.S. Lee, S.B. Seo, K.-D. Sohn, S.-I. Arsovska, A.A. Chieh, C.Y. Zaidi, W.A.W. Yahya, W.N.N.W. Gongora-Rivera, F. Martinez-Marino, M. Infante-Valenzuela, A. Dippel, D. van Dam-Nolen, D.H.K. Punter, M. Wu, T.Y. Sunmonu, T.A. Adebayo, T.T. Wahab, K.W. Bello, A.H. Sundseth, A. Kristoffersen, E.S. Al Hashmi, A.M. Ahmad, S. Rashid, U. Rodriguez-Kadota, L. Vences, M.Á. Yalung, P.M. Brola, W. Dębiec, A. and Nguyen, T.N. Qureshi, M.M. Klein, P. Yamagami, H. Abdalkader, M. Mikulik, R. Sathya, A. Mansour, O.Y. Czlonkowska, A. Lo, H. Field, T.S. Charidimou, A. Banerjee, S. Yaghi, S. Siegler, J.E. Sedova, P. Kwan, J. de Sousa, D.A. Demeestere, J. Inoa, V. Omran, S.S. Zhang, L. Michel, P. Strambo, D. Marto, J.P. Nogueira, R.G. Lereis, V.P. Ma, A. Enzinger, C. Gattringer, T. Rahman, A. Bonnet, T. De Raedt, S. Lemmens, R. Ligot, N. Vandervorst, F. Conforto, A.B. Hidalgo, R.C.T. Cuervo, D.L.M. Neves, L.O. da Silva, I.L. Martins, R.T. Rebello, L.C. Santiago, I.B. Alexiev, F. Sakelarova, T. Kalpachki, R. Cora, E.A. Kelly, M.E. Pikula, A. Chen, H.-S. Chen, Y. Yang, S. Bedekovic, M.R. Čabal, M. Tenora, D. Dušek, P. Fibrich, P. Hrabanovska, E. Hlaváčová, H. Jurák, L. Kadlckova, J. Karpowicz, I. Klečka, L. Kovář, M. Neumann, J. Paloušková, H. Reiser, M. Rohan, V. Skoda, O. Škorňa, M. Šimůnek, L. Šrámek, M. Drenck, N. Sobh, K. Strbian, D. Lesaine, E. Reiner, P. Rouanet, F. Sabben, C. Boskamp, S. Mbroh, J. Nagel, S. Poli, S. Rosenkranz, M. Thomalla, G. Karapanayiotides, T. Kargiotis, O. Koutroulou, I. Palaiodimou, L. Tsivgoulis, G. Guerra, J.D.B. Huded, V. Nagendra, S. Prajapati, C. Sylaja, P.N. Sani, A.F. Ghoreishi, A. Hashemilar, M. Sadeghi-Hokmabadi, E. Rahal, F. Sabetay, S.I. Acampa, M. Adami, A. Longoni, M. Ornello, R. Renieri, L. Romoli, M. Sacco, S. Salmaggi, A. Sangalli, D. Zini, A. Fujita, K. Fukuda, H. Matsumaru, Y. Miyake, K. Ohara, N. Sakaguchi, M. Sakai, K. Shindo, S. Sonoda, K. Sugiura, Y. Takenobu, Y. Toyoda, K. Uwatoko, T. Yamamoto, R. Yazawa, Y. Yoshimoto, T. Baek, J.-H. Lee, J.S. Lee, S.B. Seo, K.-D. Sohn, S.-I. Arsovska, A.A. Chieh, C.Y. Zaidi, W.A.W. Yahya, W.N.N.W. Gongora-Rivera, F. Martinez-Marino, M. Infante-Valenzuela, A. Dippel, D. van Dam-Nolen, D.H.K. Punter, M. Wu, T.Y. Sunmonu, T.A. Adebayo, T.T. Wahab, K.W. Bello, A.H. Sundseth, A. Kristoffersen, E.S. Al Hashmi, A.M. Ahmad, S. Rashid, U. Rodriguez-Kadota, L. Vences, M.Á. Yalung, P.M. Brola, W. Dębiec, A.

Abstract

Background and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. Methods We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). Results There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. Conclusions During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT i

Published
2022

2. Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

Author

Nguyen, T.N. Qureshi, M.M. Klein, P. Yamagami, H. Mikulik, R. Etminan, N. Abdalkader, M. Mansour, O.Y. Czlonkowska, A. Lo, H. Sathya, A. Demeestere, J. Tsivgoulis, G. Sakai, N. Sedova, P. Kristoffersen, E.S. Mohammaden, M. Lereis, V.P. Scollo, S.D. Ma, A. Rahman, A. Bonnet, T. Cortier, J. Raedt, S.D. Lemmens, R. Ligot, N. Hidalgo, R.C.T. Cuervo, D.L.M. De Oliveira Neves, L. Rezende, M.T.S. Santiago, I.B. Sirakov, A. Sirakov, S. Cora, E.A. Kelly, M.E. Lavoie, P. Peeling, L. Pikula, A. Rivera, R. Chen, H.-S. Chen, Y. Fang, H. Bedekovic, M.R. Budincevic, H. Strossmayer, J.J. Čabal, M. Hrabanovska, E. Jurak, L. Kadlckova, J. Karpowicz, I. Klečka, L. Kovař, M. Neumann, J. Palouškova, H. Reiser, M. Rekova, P. Škorňa, M. Šramek, M. Vitkova, E. Žakova, L. Sobh, K. Alpay, K. Rautio, R. Strbian, D. Gentric, J.-C. Magro, E. Naggara, O. Reiner, P. Abdulazim, A. Bohmann, F.O. Boskamp, S. Gerber, J.C. Kaiser, D.P.O. Kestner, R.I. Mbroh, J. Neyazi, M. Rosenkranz, M. Poli, S. Thomalla, G. Karapanayiotides, T. Kargiotis, O. Koutroulou, I. Palaiodimou, L. Guerra, J.D.B. Huded, V. Nagendra, S. Prajapati, C. Krishna, A. Sani, A.F. Ghoreishi, A. Ilkhchi, R.B. Jalili, J. Sabetay, S.I. Raya, T.A. Acampa, M. Longoni, M. Bigliani, C.R. Castellan, L. Ornello, R. Renieri, L. Romoli, M. Sacco, S. Sangalli, D. Vigano, M. Zini, A. Tokimura, H. Sonoda, K. Todo, K. Fukuda, H. Fujita, K. Sakaguchi, M. Uno, M. Kan, I. Kosuke, M. Kono, R. Kimura, N. Yamamoto, N. Yamamoto, R. Doijiri, R. Shindo, S. Ohara, N. Imamura, H. Ogawa, T. Uwatoko, T. Kanamaru, T. Fujinaka, T. Takenobu, Y. Toyoda, K. Matsumaru, Y. Yazawa, Y. Sugiura, Y. Baek, J.-H. Kwon, Y.S. Lee, Y.H. Seo, K.-D. Sohn, S.-I. Chan, Y.C. Wan Zaidi, W.A. Barrientos-Prieto, J. Gongora-Rivera, F. Martinez-Marino, M. Calderon-Vallejo, A. Groppa, S. Pavel, L. Coutinho, J.M. Dippel, D. Rinkel, L. Van Dam-Nolen, D.H.K. Nwazor, E.O. Sunmonu, T.A. Al Hashmi, A.M. Ahmad, S. Rashid, U. Rodriguez-Kadota, L. Vences, M.A. Yalung, P.M. Dy, J.S.H. Brola, W. Dȩbi and Nguyen, T.N. Qureshi, M.M. Klein, P. Yamagami, H. Mikulik, R. Etminan, N. Abdalkader, M. Mansour, O.Y. Czlonkowska, A. Lo, H. Sathya, A. Demeestere, J. Tsivgoulis, G. Sakai, N. Sedova, P. Kristoffersen, E.S. Mohammaden, M. Lereis, V.P. Scollo, S.D. Ma, A. Rahman, A. Bonnet, T. Cortier, J. Raedt, S.D. Lemmens, R. Ligot, N. Hidalgo, R.C.T. Cuervo, D.L.M. De Oliveira Neves, L. Rezende, M.T.S. Santiago, I.B. Sirakov, A. Sirakov, S. Cora, E.A. Kelly, M.E. Lavoie, P. Peeling, L. Pikula, A. Rivera, R. Chen, H.-S. Chen, Y. Fang, H. Bedekovic, M.R. Budincevic, H. Strossmayer, J.J. Čabal, M. Hrabanovska, E. Jurak, L. Kadlckova, J. Karpowicz, I. Klečka, L. Kovař, M. Neumann, J. Palouškova, H. Reiser, M. Rekova, P. Škorňa, M. Šramek, M. Vitkova, E. Žakova, L. Sobh, K. Alpay, K. Rautio, R. Strbian, D. Gentric, J.-C. Magro, E. Naggara, O. Reiner, P. Abdulazim, A. Bohmann, F.O. Boskamp, S. Gerber, J.C. Kaiser, D.P.O. Kestner, R.I. Mbroh, J. Neyazi, M. Rosenkranz, M. Poli, S. Thomalla, G. Karapanayiotides, T. Kargiotis, O. Koutroulou, I. Palaiodimou, L. Guerra, J.D.B. Huded, V. Nagendra, S. Prajapati, C. Krishna, A. Sani, A.F. Ghoreishi, A. Ilkhchi, R.B. Jalili, J. Sabetay, S.I. Raya, T.A. Acampa, M. Longoni, M. Bigliani, C.R. Castellan, L. Ornello, R. Renieri, L. Romoli, M. Sacco, S. Sangalli, D. Vigano, M. Zini, A. Tokimura, H. Sonoda, K. Todo, K. Fukuda, H. Fujita, K. Sakaguchi, M. Uno, M. Kan, I. Kosuke, M. Kono, R. Kimura, N. Yamamoto, N. Yamamoto, R. Doijiri, R. Shindo, S. Ohara, N. Imamura, H. Ogawa, T. Uwatoko, T. Kanamaru, T. Fujinaka, T. Takenobu, Y. Toyoda, K. Matsumaru, Y. Yazawa, Y. Sugiura, Y. Baek, J.-H. Kwon, Y.S. Lee, Y.H. Seo, K.-D. Sohn, S.-I. Chan, Y.C. Wan Zaidi, W.A. Barrientos-Prieto, J. Gongora-Rivera, F. Martinez-Marino, M. Calderon-Vallejo, A. Groppa, S. Pavel, L. Coutinho, J.M. Dippel, D. Rinkel, L. Van Dam-Nolen, D.H.K. Nwazor, E.O. Sunmonu, T.A. Al Hashmi, A.M. Ahmad, S. Rashid, U. Rodriguez-Kadota, L. Vences, M.A. Yalung, P.M. Dy, J.S.H. Brola, W. Dȩbi

Abstract

Background Prior studies indicated a decrease in the incidences of aneurysmal subarachnoid haemorrhage (aSAH) during the early stages of the COVID-19 pandemic. We evaluated differences in the incidence, severity of aSAH presentation, and ruptured aneurysm treatment modality during the first year of the COVID-19 pandemic compared with the preceding year. Methods We conducted a cross-sectional study including 49 countries and 187 centres. We recorded volumes for COVID-19 hospitalisations, aSAH hospitalisations, Hunt-Hess grade, coiling, clipping and aSAH in-hospital mortality. Diagnoses were identified by International Classification of Diseases, 10th Revision, codes or stroke databases from January 2019 to May 2021. Results Over the study period, there were 16 247 aSAH admissions, 344 491 COVID-19 admissions, 8300 ruptured aneurysm coiling and 4240 ruptured aneurysm clipping procedures. Declines were observed in aSAH admissions (-6.4% (95% CI-7.0% to-5.8%), p=0.0001) during the first year of the pandemic compared with the prior year, most pronounced in high-volume SAH and high-volume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentations of subarachnoid haemorrhage (SAH) (mild:-5% (95% CI-5.9% to-4.3%), p=0.06; moderate:-8.3% (95% CI-10.2% to-6.7%), p=0.06) but no difference in higher SAH severity. The ruptured aneurysm clipping rate remained unchanged (30.7% vs 31.2%, p=0.58), whereas ruptured aneurysm coiling increased (53.97% vs 56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%, p=0.12). Conclusion During the first year of the pandemic, there was a decrease in aSAH admissions volume, driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the ruptured aneurysm coiling rate but neither change in the ruptured aneurysm clipping rate nor change in aSAH in-hospital mortality. Trial registration number NCT04934020. © Author(s) (or their employer(s)) 2022. No com

Published
2022

3. Intravenous Thrombolysis in Posterior versus Anterior Circulation Stroke: Clinical Outcome Differs Only in Patients with Large Vessel Occlusion.

Author

Halúsková S, Herzig R, Mikulík R, Bělašková S, Reiser M, Jurák L, Václavík D, Bar M, Klečka L, Řepík T, Šigut V, Tomek A, Hlinovský D, Šaňák D, Vyšata O, Vališ M, and On Behalf Of The Czech Sits Investigators

Abstract

The safety and efficacy of intravenous thrombolysis (IVT) are well established in anterior circulation stroke (ACS) but are much less clear for posterior circulation stroke (PCS). The aim of this study was to evaluate the occurrence of parenchymal hematoma (PH) and 3-month clinical outcomes after IVT in PCS and ACS. In an observational, cohort multicenter study, we analyzed data from ischemic stroke patients treated with IVT prospectively collected in the SITS (Safe Implementation of Treatments in Stroke) registry in the Czech Republic between 2004 and 2018. Out of 10,211 patients, 1166 (11.4%) had PCS, and 9045 (88.6%) ACS. PH was less frequent in PCS versus ACS patients: 3.6 vs. 5.9%, odds ratio (OR) = 0.594 in the whole set, 4.4 vs. 7.8%, OR = 0.543 in those with large vessel occlusion (LVO), and 2.2 vs. 4.7%, OR = 0.463 in those without LVO. At 3 months, PCS patients compared with ACS patients achieved more frequently excellent clinical outcomes (modified Rankin scale [mRS] 0-1: 55.5 vs. 47.6%, OR = 1.371 in the whole set and 49.2 vs. 37.6%, OR = 1.307 in those with LVO), good clinical outcomes (mRS 0-2: 69.9 vs. 62.8%, OR = 1.377 in the whole set and 64.5 vs. 50.5%, OR = 1.279 in those with LVO), and had lower mortality (12.4 vs. 16.6%, OR = 0.716 in the whole set and 18.4 vs. 25.5%, OR = 0.723 in those with LVO) ( p < 0.05 in all cases). In PCS versus ACS patients, an extensive analysis showed a lower risk of PH both in patients with and without LVO, more frequent excellent and good clinical outcomes, and lower mortality 3 months after IVT in patients with LVO.

Published
2024
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4. Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019.

Author

Mikulík R, Bar M, Bělašková S, Černík D, Fiksa J, Herzig R, Jura R, Jurák L, Klečka L, Neumann J, Ostrý S, Šaňák D, Ševčík P, Škoda O, Šrámek M, Tomek A, and Václavík D

Subjects
Administration, Intravenous, Aged, Aged, 80 and over, Cerebral Hemorrhage complications, Czech Republic, Female, Fibrinolytic Agents adverse effects, Humans, Male, Middle Aged, Thrombolytic Therapy adverse effects, Thrombolytic Therapy methods, Tissue Plasminogen Activator, Treatment Outcome, Brain Ischemia complications, Stroke therapy
Abstract

Background The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door-to-needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome. Methods and Results Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3 months, and secondary outcomes were parenchymal hemorrhage/intracerebral hemorrhage (ICH), any ICH, and death. Of 31 316 patients treated with intravenous thrombolysis alone, 18 861 (60%) had available data: age 70±13 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5-14), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and >60 minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74 minutes in 2004 to 22 minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage/ICH, any ICH, and mortality. Patients with DNT ≤20 minutes, 21 to 40 minutes, and 41 to 60 minutes as compared with DNT >60 minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12-1.51), 1.33 (95% CI, 1.15-1.54), and 1.15 (95% CI, 1.02-1.29), and for parenchymal hemorrhage/ICH: 0.57 (95% CI, 0.45-0.71), 0.76 (95% CI, 0.61-0.94), 0.83 (95% CI, 0.70-0.99), respectively. Conclusions Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20 minutes from arrival to a hospital.

Published
2022
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5. Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality.

Author

Nguyen TN, Qureshi MM, Klein P, Yamagami H, Abdalkader M, Mikulik R, Sathya A, Mansour OY, Czlonkowska A, Lo H, Field TS, Charidimou A, Banerjee S, Yaghi S, Siegler JE, Sedova P, Kwan J, de Sousa DA, Demeestere J, Inoa V, Omran SS, Zhang L, Michel P, Strambo D, Marto JP, Nogueira RG, Kristoffersen ES, Tsivgoulis G, Lereis VP, Ma A, Enzinger C, Gattringer T, Rahman A, Bonnet T, Ligot N, De Raedt S, Lemmens R, Vanacker P, Vandervorst F, Conforto AB, Hidalgo RCT, Mora Cuervo DL, de Oliveira Neves L, Lameirinhas da Silva I, Martíns RT, Rebello LC, Santiago IB, Sakelarova T, Kalpachki R, Alexiev F, Cora EA, Kelly ME, Peeling L, Pikula A, Chen HS, Chen Y, Yang S, Roje Bedekovic M, Čabal M, Tenora D, Fibrich P, Dušek P, Hlaváčová H, Hrabanovska E, Jurák L, Kadlčíková J, Karpowicz I, Klečka L, Kovář M, Neumann J, Paloušková H, Reiser M, Rohan V, Šimůnek L, Skoda O, Škorňa M, Šrámek M, Drenck N, Sobh K, Lesaine E, Sabben C, Reiner P, Rouanet F, Strbian D, Boskamp S, Mbroh J, Nagel S, Rosenkranz M, Poli S, Thomalla G, Karapanayiotides T, Koutroulou I, Kargiotis O, Palaiodimou L, Barrientos Guerra JD, Huded V, Nagendra S, Prajapati C, Sylaja PN, Sani AF, Ghoreishi A, Farhoudi M, Sadeghi Hokmabadi E, Hashemilar M, Sabetay SI, Rahal F, Acampa M, Adami A, Longoni M, Ornello R, Renieri L, Romoli M, Sacco S, Salmaggi A, Sangalli D, Zini A, Sakai K, Fukuda H, Fujita K, Imamura H, Kosuke M, Sakaguchi M, Sonoda K, Matsumaru Y, Ohara N, Shindo S, Takenobu Y, Yoshimoto T, Toyoda K, Uwatoko T, Sakai N, Yamamoto N, Yamamoto R, Yazawa Y, Sugiura Y, Baek JH, Lee SB, Seo KD, Sohn SI, Lee JS, Arsovska AA, Chieh CY, Wan Zaidi WA, Wan Yahya WNN, Gongora-Rivera F, Martinez-Marino M, Infante-Valenzuela A, Dippel D, van Dam-Nolen DHK, Wu TY, Punter M, Adebayo TT, Bello AH, Sunmonu TA, Wahab KW, Sundseth A, Al Hashmi AM, Ahmad S, Rashid U, Rodriguez-Kadota L, Vences MÁ, Yalung PM, Dy JSH, Brola W, Dębiec A, Dorobek M, Karlinski MA, Labuz-Roszak BM, Lasek-Bal A, Sienkiewicz-Jarosz H, Staszewski J, Sobolewski P, Wiącek M, Zielinska-Turek J, Araújo AP, Rocha M, Castro P, Ferreira P, Nunes AP, Fonseca L, Pinho E Melo T, Rodrigues M, Silva ML, Ciopleias B, Dimitriade A, Falup-Pecurariu C, Hamid MA, Venketasubramanian N, Krastev G, Haring J, Ayo-Martin O, Hernandez-Fernandez F, Blasco J, Rodríguez-Vázquez A, Cruz-Culebras A, Moniche F, Montaner J, Perez-Sanchez S, García Sánchez MJ, Guillán Rodríguez M, Bernava G, Bolognese M, Carrera E, Churojana A, Aykac O, Özdemir AÖ, Bajrami A, Senadim S, Hussain SI, John S, Krishnan K, Lenthall R, Asif KS, Below K, Biller J, Chen M, Chebl A, Colasurdo M, Czap A, de Havenon AH, Dharmadhikari S, Eskey CJ, Farooqui M, Feske SK, Goyal N, Grimmett KB, Guzik AK, Haussen DC, Hovingh M, Jillela D, Kan PT, Khatri R, Khoury NN, Kiley NL, Kolikonda MK, Lara S, Li G, Linfante I, Loochtan AI, Lopez CD, Lycan S, Male SS, Nahab F, Maali L, Masoud HE, Min J, Orgeta-Gutierrez S, Mohamed GA, Mohammaden M, Nalleballe K, Radaideh Y, Ramakrishnan P, Rayo-Taranto B, Rojas-Soto DM, Ruland S, Simpkins AN, Sheth SA, Starosciak AK, Tarlov NE, Taylor RA, Voetsch B, Zhang L, Duong HQ, Dao VP, Le HV, Pham TN, Ton MD, Tran AD, Zaidat OO, Machi P, Dirren E, Rodríguez Fernández C, Escartín López J, Fernández Ferro JC, Mohammadzadeh N, Suryadevara NC, de la Cruz Fernández B, Bessa F, Jancar N, Brady M, and Scozzari D

Abstract

Background and Purpose: Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year., Methods: We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020)., Results: There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths., Conclusions: During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Published
2022
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6. Prehospital stroke scale (FAST PLUS Test) predicts patients with intracranial large vessel occlusion.

Author

Václavík D, Bar M, Klečka L, Holeš D, Čábal M, and Mikulík R

Subjects
Adult, Aged, Aged, 80 and over, Arm physiopathology, Arterial Occlusive Diseases etiology, Arterial Occlusive Diseases physiopathology, Brain diagnostic imaging, Brain physiopathology, Computed Tomography Angiography, Czech Republic, Face physiopathology, Female, Humans, Leg physiopathology, Male, Middle Aged, Paresis etiology, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Stroke complications, Young Adult, Arterial Occlusive Diseases diagnosis, Emergency Medical Services methods, Paresis diagnosis, Paresis physiopathology, Stroke diagnosis, Stroke physiopathology
Abstract

Background and Purpose: Mechanical thrombectomy (MT) is indicated for the treatment of large vessel occlusion (LVO) stroke. MT should be provided as quickly as possible; therefore, a test identifying suspected LVO in the prehospitalization stage is needed to ensure direct transport to a comprehensive stroke center (CSC). We assume that patients with clinically severe hemiparesis have a high probability of LVO stroke. We modified the FAST test into the FAST PLUS test: The first part is the FAST test and the second part evaluates the presence of severe arm or leg motor deficit. This prospective multicenter study evaluates the specificity and sensitivity of the FAST PLUS test in detecting LVO stroke., Methods: Paramedics were trained through e-learning to conduct the FAST PLUS test. All prehospital suspected stroke patients who were administered the FAST PLUS test were included. Demographics, National Institutes of Health Stroke Scale (NIHSS) score, brain computed tomography (CT), and CT angiography (CTA) were recorded. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating curve (ROC) area for LVO were calculated., Results: The study included 435 patients. LVO were found in 124 patients (28%). Sensitivity was 93%, specificity was 47%, PPV was 41%, NPV was 94%, and ROC area for ICA/MCA occlusion was 0.65. Intracerebral hemorrhage (ICH) was identified in 48 patients (11%)., Conclusion: We found that the FAST PLUS test had a high sensitivity for LVO stroke. Of the 435 patients, 41% were all directly transported to a CSC based on positive FAST PLUS test scores and were potential candidates for MT., (© 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.)

Published
2018
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