7 research outputs found
Outcomes of cerebral venous thrombosis due to vaccine-induced immune thrombotic thrombocytopenia after the acute phase
© 2022 American Heart Association, Inc.Background:
Cerebral venous thrombosis (CVT) due to vaccine-induced immune thrombotic thrombocytopenia (VITT) is a severe condition, with high in-hospital mortality rates. Here, we report clinical outcomes of patients with CVT-VITT after SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) vaccination who survived initial hospitalization.
Methods:
We used data from an international registry of patients who developed CVT within 28 days of SARS-CoV-2 vaccination, collected until February 10, 2022. VITT diagnosis was classified based on the Pavord criteria. Outcomes were mortality, functional independence (modified Rankin Scale score 0â2), VITT relapse, new thrombosis, and bleeding events (all after discharge from initial hospitalization).
Results:
Of 107 CVT-VITT cases, 43 (40%) died during initial hospitalization. Of the remaining 64 patients, follow-up data were available for 60 (94%) patients (37 definite VITT, 9 probable VITT, and 14 possible VITT). Median age was 40 years and 45/60 (75%) patients were women. Median follow-up time was 150 days (interquartile range, 94â194). Two patients died during follow-up (3% [95% CI, 1%â11%). Functional independence was achieved by 53/60 (88% [95% CI, 78%â94%]) patients. No new venous or arterial thrombotic events were reported. One patient developed a major bleeding during follow-up (fatal intracerebral bleed).
Conclusions:
In contrast to the high mortality of CVT-VITT in the acute phase, mortality among patients who survived the initial hospitalization was low, new thrombotic events did not occur, and bleeding events were rare. Approximately 9 out of 10 CVT-VITT patients who survived the acute phase were functionally independent at follow-up.This study was funded by the Netherlands Organisation for Health Research and Development (ZonMw, grant number 10430072110005), the Dr. C.J. Vaillant Foundation, and Hospital District of Helsinki and Uusimaa (grant TYH2022223).info:eu-repo/semantics/publishedVersio
Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19
Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28â54) vs 45 (28â56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28â79) vs 68 (30â125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19â62) vs 53 (20â92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.</p
Apport des activitĂ©s cĂ©rĂ©brales gamma comme mĂ©thode de cartographie fonctionnelle et marqueur du devenir cognitif dans le bilan prĂ©-chirurgie de lâĂ©pilepsie. Comparaison avec les stimulations Ă©lectriques cĂ©rĂ©brales et lâIRM fonctionnelle lors dâune tĂąche de langage
The present study compared language mapping with language-induced Gamma Band Responses (GBRs) and Electro-Cortical Stimulation (ECS) and functional neuroimaging (fMRI), in patient with intracranial electrodes and evaluated the clinical relevance of GBRs to predict post-operative language outcome. Fourteen subjects with intractable epilepsy candidates for epilepsy surgery underwent intracranial EEG (iEEG) monitoring. During iEEG, conventional ECS and a language task (Lec1) involving two language processes (semantic and phonological) were performed. Thus we obtained iEEG signals, analysed in terms of GBRs (50â150 Hz) and behavioural features. In addition, a sub-group of 6 patients performed a language fMRI mapping. After surgery, the same language task (Lec1) was performed. Statistical analyses were computed: i) at every tested cortical site, language-induced GBRs were compared to language responses elicited by ECS, and fMRI results ii) post-operative outcomes of patients who underwent a resection upon cortical sites that exhibit language-induced GBRs were compared to post-operative outcomes of the other patients. Language-induced GBRs during predict ECS language interference and fMRI results with high specificity but low sensibility. Resections upon sites that showed language-related GBRs were not associated with more significant language post-operative decline. This study supports the feasibility of pre-surgical language mapping with language-induced GBRs. It supports the use of GBRs as a complementary tool of ECS and fMRI, as a screening method to perform preliminary functional maps to reduce ECS duration.Cette Ă©tude vise Ă Ă©valuer lâapport des Gamma Band Responses (GBRs) comme mĂ©thode de cartographie fonctionnelle par rapport aux Stimulation Corticales Electriques (SCE) et Ă lâIRMf et comme marqueur du devenir cognitif dans le bilan prĂ©-chirurgie de lâĂ©pilepsie. 14 patients prĂ©sentant une Ă©pilepsie pharmaco-rĂ©sistante ayant subi une cortectomie ont Ă©tĂ© inclus. Ils Ă©taient soumis Ă i) un bilan prĂ©-opĂ©ratoire comprenant une Ă©valuation en EGG intracrĂąnien (EEGi) durant laquelle ils Ă©taient soumis Ă des SCE ainsi quâĂ une tĂąche de langage LEC1. Ceci a permis dâobtenir des performances comportementales et du signal EEGi, analysĂ© Ă la recherche de GBRs. De plus, un sous-groupe de 6 patients a bĂ©nĂ©ficiĂ© dâune cartographie du langage par IRMf ii) une Ă©valuation post-opĂ©ratoire par Lec1. Les rĂ©sultats de la recherche de GBRs ont Ă©tĂ© comparĂ©s avec ceux des SCE et de lâIRMf pour chaque site cĂ©rĂ©bral explorĂ© en SCE. ii) Le devenir langagier post-opĂ©ratoires des patients ayant subi une rĂ©section comportant un site ayant enregistrĂ© des GBRs a Ă©tĂ© comparĂ© avec ceux dont les sites GBR+ Ă©taient Ă©pargnĂ©s (groupe contrĂŽle). Les GBRs ont prĂ©dit les rĂ©sultats des SCE et de lâIRMf avec une faible sensibilitĂ© mais une forte spĂ©cificitĂ©. Les avantages des GBRs ont Ă©tĂ© soulignĂ©s. Les performances langagiĂšres post-opĂ©ratoires en cas de rĂ©section incluant un site ayant enregistrĂ© des GBRS nâĂ©taient pas significativement diffĂ©rentes de celles du groupe contrĂŽle. Nos rĂ©sultats confirment la faisabilitĂ© des GBRs induites dans le bilan prĂ©-chirurgical de lâĂ©pilepsie pharmaco-rĂ©sistante et lâintĂ©rĂȘt dâune cartographie prĂ©-chirurgicale multi-modalitaire
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Successful Thrombectomy Improves Functional Outcome in Tandem Occlusions with a Large Ischemic Core
International audienceBackground: Emergent stenting in tandem occlusions and mechanical thrombectomy (MT) of acute ischemic stroke related to large vessel occlusion (LVO-AIS) with a large core are tested independently. We aim to assess the impact of reperfusion with MT in patients with LVO-AIS with a large core and a tandem occlusion and to compare the safety of reperfusion between large core with tandem and nontandem occlusions in current practice. Methods: We analyzed data of all consecutive patients included in the prospective Endovascular Treatment in Ischemic Stroke Registry in France between January 2015 and March 2023 who presented with a pretreatment ASPECTS (Alberta Stroke Program Early CT Score) of 0â5 and angiographically proven tandem occlusion. The primary end point was a favorable outcome defined by a modified Rankin Scale (mRS) score of 0â3 at 90 days. Results: Among 262 included patients with a tandem occlusion and ASPECTS 0â5, 203 patients (77.5%) had a successful reperfusion (modified Thrombolysis in Cerebral Infarction grade 2b-3). Reperfused patients had a favorable shift in the overall mRS score distribution (adjusted odds ratio [aOR], 1.57 [1.22â2.03]; P < 0.001), higher rates of mRS score 0â3 (aOR, 7.03 [2.60â19.01]; P < 0.001) and mRS score 0â2 at 90 days (aOR, 3.85 [1.39â10.68]; P = 0.009) compared with nonreperfused. There was a trend between the occurrence of successful reperfusion and a decreased rate of symptomatic intracranial hemorrhage (aOR, 0.5 [0.22â1.13]; P = 0.096). Similar safety outcomes were observed after large core reperfusion in tandem and nontandem occlusions. Conclusions: Successful reperfusion was associated with a higher rate of favorable outcome in large core LVO-AIS with a tandem occlusion, with a safety profile similar to nontandem occlusion
Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry
BACKGROUND AND OBJECTIVES: COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19. METHODS: Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT). RESULTS: Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60). DISCUSSION: Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis
Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.
BACKGROUND AND OBJECTIVES
COVID-19 related inflammation, endothelial dysfunction and coagulopathy may increase the bleeding risk and lower efficacy of revascularization treatments in patients with acute ischemic stroke. We aimed to evaluate the safety and outcomes of revascularization treatments in patients with acute ischemic stroke and COVID-19.
METHODS
Retrospective multicenter cohort study of consecutive patients with acute ischemic stroke receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021, tested for SARS-CoV-2 infection. With a doubly-robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT).
RESULTS
Of a total of 15128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19. 5848 (38.7%) patients received IVT-only, and 9280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted odds ratio [OR] 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour (OR 2.47; 95% CI 1.58-3.86) and 3-month mortality (OR 1.88; 95% CI 1.52-2.33).COVID-19 patients also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60).
DISCUSSION
Patients with acute ischemic stroke and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 treated patients. Current available data does not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in COVID-19 patients, or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring and establishing prognosis